With a Patient Notebook account, you can directly contact your doctor, view your healthcare records, and easily pay your medical bills – quickly, privately and securely – all from the comfort of your computer.
Jackson Radiology Associates
P O Box 11955
Jackson, TN 38308
(888) 630 - 0845
(888) 630 - 0845
Test Mode Activated. Any transaction attempted will not be processed.
Fill out this form with your latest information:
Patient Information
*
First Name
*
Last Name
Account Number
Current Address
Address
City
State
Select
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
MP
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UM
UT
VT
VI
VA
WA
WV
WI
WY
Zip Code
Primary Insurance
Invalid date of birth
Invalid plan start date
Invalid plan end date
Subscriber Info
First Name
Middle Name
Last Name
DOB
Relationship
Select
Self
Spouse
Child
Employee
LifePartner
Insurer Info
Insurer
Group Number
Member ID
Plan Dates
-
+ Add Secondary Insurance
Secondary Insurance
Remove
Invalid date of birth
Invalid plan start date
Invalid plan end date
Subscriber Info
First Name
Middle Name
Last Name
DOB
Relationship
Select
Self
Spouse
Child
Life Partner
Insurer Info
Insurer
Group Number
Member ID
Plan Dates
-
Cancel