Patient Forms and CD Instruction Sheet
Bio-Magnetic MRI/MRA Imaging Centers uses the following forms. Some of them must be completed before the scan can take place. If you desire, you can download the forms from this page and fill them out prior to your appointment to speed up the process and reduce your waiting time. You will need Adobe Acrobat Reader to be able to view/print the following attachments. If it is not installed on your computer, you may download it free from Adobe's website.
- MRI Script (Standard - Front and Back)
- Breast Script (Standard - Front and Back)
- MRI Patient Guide (Standard - Front and Back)
- Privacy Policy - Notice of Privacy Practices (4 pages)
- Acknowledgment of Receiving Privacy Practices
- Patient Consent and Screening Form (Standard - Front and Back)
- Authorization for Release of Health Information
- Patient Medicare Authorization Form
- Automobile Accident Patient Information Form
- Blue Cross/Blue Shield Form
- Instructions for Opening and Viewing Images on MRI CD
If for some reason, you are unable to access these forms, they are available through our Marketing Department at (248) 284-2334.
