Skip to main content

You are here

Patient Forms

On this page you will find a link to our Safety Screening Form. This form will assist us in collecting critical information that allows us to ensure you can safely enter our MRI unit and schedule you on the MRI Machine best suited to provide the highest quality imaging for your conditions.

Many insurance companies also require prior authorization for MRI exams. We will contact your insurance and work with your provider to obtain these approvals. Some insurance companies can take more than 7 days to approve the requests. To ensure that our patients get the full value of their insurance coverage, we will not schedule MRI exams prior to having these required authorizations in place.

Paperwork Completion Instructions:

1. Complete Safety Screening form either online or by downloading a phyiscal copy. Please note we must receive completed forms prior to scheduling.

MRI machines use a strong magnetic field. Objects containing metal could move or become heated. So it is EXTREMELY important that you notify us of any medical or removable devices.

2. If you've chosen to download the form, return the physical copy via email, fax, or call for other options.

Fax: 240.313.9726
Phone: 240.313.9700 option 4 – If you are not able to complete the forms and submit back to us, one of our scheduling representatives will be happy to go over the questions with you over the phone prior to being scheduled.

3. Exam times can vary depending on type of scan and if multiple scans are being performed. An estimated appointment can be given at the time of scheduling.

We look forward to providing you with quality imaging. A scheduler will be in contact with you as soon as the above items have been received. If you have not been contacted by a member of the DIS team within 1 week please reach out to us at 240.313.9700 option 3.

Safety Screening Form