PocketHealth
Imaging Record Access
Main/Caledonia X-Ray & Ultrasound_Logo
Secure Account
Secure Online Account

Upon completion of the following online request form, your medical imaging history from Main/Caledonia X-Ray & Ultrasound 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.

Transfer fee
Transfer Fee

A transfer fee of $5.00 + HST will be charged for this request and will include all available imaging from your history at Main/Caledonia X-Ray & Ultrasound.

Info
Learn More

Visit www.mypockethealth.com to learn more about PocketHealth and the functionality of the online account where your medical imaging records will be stored.

© 2019 PocketSix Technologies Inc.
PocketHealth
Imaging Record Access
Main/Caledonia X-Ray & Ultrasound_Logo
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
/ /
OHIP Number
No OHIP Card?
-
If your health card does not have a version code (the part after the dash), please leave that part empty.
If you do not have an OHIP card, provide your alternate health ID
Please only fill one of the provided options.
Have an OHIP Card?
Email
Phone Number
First & Middle Name(s)
Last Name
Date of Birth
OHIP
MRN
Other Health ID
SSN
IPN
Email
Phone Number
2. Consent
2. Consent
Consent

Are you a delegate of the patient?
Are you the patient themselves?
Delegate's Full Name
Relation to Patient
Address
Phone Number
Authorization Document
Attach file Change ×
Please provide supporting documentation affirming your status as an authorized representative of the patient. 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
3. Secure Payment
3. Secure Payment
A transfer fee of $5.00 + HST will apply.
Please submit your payment details in the secure form below:
Card Number
Card Expiry
CVV
What is CVV?
Secure
PocketHealth does not store your credit card information at any point in time.
This page is secured by bank-level encryption standards.
Having trouble?
Call PocketHealth Support,
toll-free at 1-855-381-8522.
Having trouble? Call PocketHealth Support, toll-free at 1-855-381-8522.
© 2019 PocketSix Technologies 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 Main/Caledonia X-Ray & Ultrasound 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

Have imaging records
at another healthcare facility?
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    © 2019 PocketSix Technologies 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.

    No Ohip Number

    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.