Request IHS Assistance - Imaging Healthcare Specialists

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Request for IHS Assistance

Please complete all fields to ensure our team’s ability to provide a quick resolution for you.

Enter Physician/Provider Information
*All fields are required

Physician/Provider Request *
CALL TODAY BY EOB
URGENT: PATIENT WAITING
URGENT: PHYSICIAN REQUIRES ASSISTANCE

Physician Last Name*

Physician First Name*

Suffix *

Specialty *

Official Group/Practice Name*

Street Address *

Suite

City*

State *

Zip *

Phone +Ext.*

Fax*

Physician/Provider Email*
Enter Email

MyIHS User Name*

Assistance Required: * (Choose all that Apply)

Unable to view images/reports
Printing Images – ICA/MD Portal
Error Messages
Printing Reports
Locked Out/Forgot Password

Who is Locked out?* Phys/Provider
Staff Member

Request Portal Access (MA/Staff)
Request Referral Pads
(Will be mailed next business day)
Request ICA Access –
Providers Only Access
Other – Explain Reason:

Patient Information

Provide patient name for any report/image related concern

Patient Last Name

Patient First Name

Patient Date of Birth

Caller Contact Information *All fields are required

Contact Information +Ext.*

Enter FULL Name – Office Contact*

Request Submitted By *

Title *

Contact Us!

Call

858-658-6500

Email

info@imaginghealthcare.com

Fax

866-558-4329

IMAGING HEALTHCARE SPECIALISTS

Servicing Southern California and San Diego County.

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