X-Ray Loaner Forms/Second Request Cards

Use the Hospital Time Savers method for releasing and retrieving x-ray films that are hand delivered or mailed to doctors, hospitals or patients.

When x-rays are requested, all you need to do is fill in the blanks on our easy to use 5 1/4" x 4 1/2" three (3) part form. Write it once and you have a completed:

1. Mailing label
2. Log and release form
3. Follow-up post card*

Just one step duplicates a form for mailing, logging and retrieval of x-rays.

For patient privacy, order our four (4) part form. In addition to the same three parts, this loaner form has an additional cover sheet without personal patient information.

Item #101 (3 part form)
250 ct. pack...$115.00
500 ct. pack...$155.00
1000 ct. pack...$210.00

Item #444 (4 part form)
250 ct. pack...$105.00
500 ct. pack...$145.00
1000 ct. pack...$195.00
Imprinted with ordering facility address.
Imprinting included in price.

Order x-ray loaner forms

To protect x-ray films, you need the Loaner Jacket. Click here for information.

Need to send another reminder for film retrieval? Order the Second Request post cards.

Item #201
100 ct. pack...$15.00

Order Second Request Cards Now!