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How much will it cost? | What to Expect? | Patient Forms

DOWNLOADABLE FORMS

If you have been scheduled for a MRI study at Central Imaging High Field Open MRI, you may print the patient information and medical history forms directly from our website. Please have them fully completed and signed when you arrive for your MRI appointment. Additionally, there is a MAP with our address and phone numbers, in the event that you do not know where our facilities are located.

To view and print the forms, you must have Adobe Acrobat Reader. You can download it for free by clicking here.

EnglishSpanish
Authorization for treatment and payment responsibility.

Form 2
Assignment of Insurance benefits

Form 3
MRI Patient screening.

Form 4
Consent form and information release.

EnglishSpanish
Patient Information - English

NOTICE TO PATIENTS: EnglishSpanish












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