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Image or Report Request Form

Please use Atlantic Medical Imaging’s Online Image or Report Request Form when you need to pick up your images or reports or to have us mail them directly to your physician or to you at the address we have on file. Please allow two business days (48 hours) from your request for processing.

For urgent requests contact us at 609-677-9729, Option #3

(This will only be utilized for confirmation that we have received the online request)

Please provide the 10 digit primary phone number to contact you during daytime hours. Any additional phone numbers we may use should also be listed.

Unless you indicate the exact date(s) of service we must contact you to confirm which images you are requesting.

To assure your privacy, all individuals picking up films will be required to provide a picture ID
Privacy Laws prohibit the release of medical images and/or reports to a (non-physician) third party without the patient's written permission.