We appreciate your patient referral. We take online security seriously.

This form is to comply with HIPPA and associate your order with the proper medical practice.

The first section allows Snap to associate your order with the correct medical practice and simplifies the information you must provide with the medical order.

The Validation Code process allows us to confirm the medical order is coming from your medical practice.

Preparing an Online Medical Order
If you upload a Continuity of Care Document (CCD/CCDA) from your Electronic Health Record we can prepopulate much of the personal health information needed and simplify your patient referral.