IDFAX Services 

    

Request a Service

If you encounter technical difficulties in sending this form, please submit your request by e-mail to: services@idfax.com, or by fax to: (860) 286-0249, or by mail to: IDFAX , 38 High Hill Road, Bloomfield, CT 06002, USA.

If you require more than one service, please submit a separate request for each additional service.
I am requesting a [must select one service]:

    Patient Record Review
    Medical Chart Review 
  
 I am [must select one choice]:
    a legal professional
    an organization
    a business
    other
[must fill in red items]

    Name of Business/Organization:
    Your Name:
Street/P.O. Box/Apt.:
  
  City/Town:
  State:  Zip:
  Country:
  E-mail:

Describe the specifics of your request (no limit on length):
    

                                   
I D F A X   can be reached at:
    phone/fax: (860) 286-0249    |||     e-mail: services@idfax.com
38 High Hill Road, Bloomfield, CT 06002
This site has been on the World Wide Web since June 18, 2001
Copyright © 1999-2006 IDFAX ® § Created and maintained by BOOM! Enterprises®, last revised - January 1, 2006