Request Hospital/Pharmacy Form

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Please Check Appropriate Search Request

Hospital Search
Pharmacy Search
Acupuncture Search
Health Clinics/Doctor Search
Imaging Search(X-ray/MRI/Cat Scan)
Orthopedic Search
Neurology Search
Cardiology Search
Podiatry Search
Chiropractor Search
Optometry/Ophthalmology Search
Ear, Nose & Throat Search
Authorization to extend search beyond 15 (Add. charge to hospital, pharmacy, doctor, etc.)
Internet Search
Criminal Search

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800.472.7701 - Toll Free

800.472.7801 - Fax

219.663.2626 - Office

786.514.8828 - Florida

630.592.1301 - After hours

630.995.5195 - Sales