Complaints Against a Facility

Certificates Inquiry

Name(Required)

First Last

E-mail Address(Required)

Phone

Select Modality(Required)

Application Number(Required)

Which applies to you regarding your IAC Certificates:(Required)

I have not received e-mail invitation to order IAC certificates.

I ordered IAC certificates in the system, but have not yet received them.

I made changes in my IAC online application and need new copies of certificates.

Certificates arrived, but are damaged or there is an error on them.

Other

Comments / Questions

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Name

This field is for validation purposes and should be left unchanged.

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Name(Required)

First Last

Email(Required)

Phone(Required)

For which modality(ies) are you inquiring about?(Required)

Vascular Testing

Echocardiography

Nuclear/PET

MRI

CT / Dental CT

Carotid Stenting

Vascular Interventional/Vein Center

Cardiac Electrophysiology

Cardiovascular Catheterization

Select one or more.

Application or Account Number(Required)

If you have an existing IAC Online Accreditation Account, please enter your Application or Account number for reference. If not applicable, enter N/A.

Question(Required)

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Information Of Person Filing Complaint

Information Regarding Complaint

Certificates Inquiry

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