RIA EMR Request Form

Thank you for your interest in connecting your EMR with us to receive reports electronically.

If your practice is interested in exploring the opportunity to receive all your patients’ reports electronically, it is recommended you contact your EMR vendor as there maybe configuration required and associated costs from your EMR vendor for the interface.

Please complete this form and submit your request. An RIA Information Services representative will contact you within one business day at the number you provide.

Thank you

Radiology Imaging Associates

Practice Information

Practice Name *

Practice Contact *

Phone: *

Email *

EMR Vendor Information

EMR Vendor *

EMR Vendor Contact *

Phone *

Email *

Anticipated Go Live Date *

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