Request – Golden State Radiology

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California Teleradiology Service Request Form

To ensure we provide the most tailored and effective teleradiology solutions for your facility, we kindly ask that you complete the Service Request Form with as much detail as possible. Accurately specifying the hours of coverage you require, along with the expected volumes by modality during these hours, is crucial. This information helps us understand your needs thoroughly and allows us to allocate the appropriate resources and expertise to enhance your service delivery. By furnishing complete and precise details, you enable us to craft a customized response that aligns perfectly with your operational requirements and ultimately supports your commitment to outstanding patient care.

Thank you for taking the time to help us serve you better.

Name

First

Last

Title

DR/CEO/COO/Director/Manager - Other Work Title

Facility or Practice Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Golden State Radiology is only contracting for services in California at this time.

Phone

Email

Modalities

Please state what modalities needing interpretation, and how many per shift/week/month

Hours of Coverage

Daytime and Nighttime coverage available. Weekend day and Holiday coverage only available with either full Daytime or full Nighttime contracts.

Other Information

Golden State Radiology is committed to improving healthcare in California by providing timely and precise radiological reports and fostering better diagnostic outcomes and patient care.