For your convenience, print out and complete the forms below and bring them with you to your appointment. Upon arrival, you will be given an additional questionnaire that is specific to the body part we will be scanning.
Patient Information - to be completed by all patients
Safety Questionnaire and Consent - to be completed by all patients
Please notify us for further instructions if you:
~ Have a pacemaker, defibrillator, artificial heart valve, cochlear implant, aneurysm clips or a neurostimulator
~ Have any implants in your body
~ Are pregnant or could be pregnant
~ Have ever worked as a metal workers
~ Have a history of metal in the eyes
Jewelry and other accessories should be left at home if possible, or removed prior to the MRI scan. Metal and electronic objects are not allowed in the exam room and can interfere with the magnetic field of the MRI unit. These items include:
~ Jewelry, watches, credit cards, cell phones and hearing aids, all of which can be damaged
~ Pens, pocketknives and eyeglasses
~ Hairpins, metal zippers and similar metallic items
~ Removable dental work
~ Body piercings
If you have additional questions or concerns, please contact our office and our patient friendly staff will be glad to assist you
Patient Information - to be completed by all patients
Safety Questionnaire and Consent - to be completed by all patients
Please notify us for further instructions if you:
~ Have a pacemaker, defibrillator, artificial heart valve, cochlear implant, aneurysm clips or a neurostimulator
~ Have any implants in your body
~ Are pregnant or could be pregnant
~ Have ever worked as a metal workers
~ Have a history of metal in the eyes
Jewelry and other accessories should be left at home if possible, or removed prior to the MRI scan. Metal and electronic objects are not allowed in the exam room and can interfere with the magnetic field of the MRI unit. These items include:
~ Jewelry, watches, credit cards, cell phones and hearing aids, all of which can be damaged
~ Pens, pocketknives and eyeglasses
~ Hairpins, metal zippers and similar metallic items
~ Removable dental work
~ Body piercings
If you have additional questions or concerns, please contact our office and our patient friendly staff will be glad to assist you
