PocketHealth
Imaging Record Access
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Secure Account
Secure Online Account

Upon completion of the following online request form, your medical imaging history from will be transferred to you into a secure account maintained by PocketHealth, a third-party platform.

Permanent Account
Permanent Access

Once transferred, your record will be maintained permanently within your PocketHealth account for you to access, view, download, or share with a healthcare professional.

Info
Learn More

Visit pocket.health/patients to learn more about PocketHealth and the functionality of the online account where your medical imaging records will be stored.

© 2020 PocketHealth Inc.
PocketHealth
Imaging Record Access
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1. Patient Information
Patient Information
First & Middle Name(s)
Last Name
As it appears on your health card. Please include any middle name(s) that appear on your health card.
Date of Birth
/ /
Email
Phone Number
First & Middle Name(s)
Last Name
Date of Birth
MRN
Other Health ID
SSN
IPN
Email
Phone Number
2. Recent Exam Information
2. Recent Exam Information
Recent Exam Information
We need some additional details about your most recent exam in order to process your request.
Exam Type
If you had several exams performed on the same day, you can provide the details for any one of these exams.
Exam Site
Please select the name of the hospital your most recent exam was performed at.
Exam Date
Month
Year
Please indicate the month and year of your most recent exam.
Home Address
Street Number

Street Name

Postal Code
Please provide your full home address from the time of your most recent exam.
Exam Type
Exam Site
Exam Date
Home Address
,
2. Consent
2. Consent
Consent

Are you the patient themselves?
Delegate's Full Name
Relation to Patient
Home Address
Phone Number
Authorization Document
Attach file Change ×
Please provide supporting documentation affirming your status as an authorized representative of the patient. If you are a parent/guardian, you may submit government-issued identification for yourself and your child. You may attach any image file or a PDF document.
Signature
By tapping or clicking and dragging using your mouse, please provide your signature below in acknowledgement of your consent:
Reset Signature
Having trouble?
Call PocketHealth Support,
toll-free at 1-855-381-8522.
Having trouble? Call PocketHealth Support, toll-free at 1-855-381-8522.
© 2020 PocketHealth Inc.
PocketHealth
Thank you. Your request has been submitted for processing.
For reference, your Request ID is
Email Time

Within 1-2 business days of the study being finalized, an email with a secure access link to your imaging will be sent:

Subject:
Your Imaging records from are Ready to View
From:
secure@mypockethealth.com
To:

Search in Junk Mail

Please be sure to check your junk mail / spam folders for the email if you have not received it within the specified time period.

Have a question

If you have any questions please feel free to reach out to PocketHealth Patient Support via email at help@mypockethealth.com

© 2020 PocketHealth Inc.

Invalid Input

Please review your inputs as some were found to contain errors. For your convenience, inputs with errors have been marked in red.
Unfortunately, you will need to visit your provider and complete your online imaging request in-person.

Please Try Another Card

Sorry, American Express is not available for this payment. We apologize for any inconvenience that this may have caused. Please try another card.

Attention: Please note that this will delay access to any future imaging. Would you like to continue?

Please note that patients under the age of 0 must request their records directly from .