We appreciate your interest in Cardiac America.
Please fill out this form for more information about our services. Someone will contact you shortly.
(All fields are required)

Full Name :
Designation/Title :
Hospital/Practice :
Office Phone :
FAX :
Address 1 :
Address 2 :
City :
State
Zip :
Email :
Please tell us what services you are interested in:
	Evening/Night coverage
	Temporary/Locums Coverage
	Day Time weekend coverage area
	Weekend Night Coverage
	A complete Teleradiology Solution including the necessary equipment
Please tell us a little about your current call situation:
	We currently take call ourselves
	We employ radiologists and cardiologists just to take call
	We use another teleradiology service
Approximately how many studies are done at your facility on an average night?
	1-5
	6-10
	11-20
	>20
	N/A
Please list approximate number of exams, exam types and whether you have DICOM output from your your 64-slice CT.

Direct    : 540.904.1388
Fax        : Toll free (800-807-1589) or Direct : 703 229 1525