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Get Mri Referral Form 2020-2025
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How to fill out the MRI referral form online
Filling out the MRI referral form online is a straightforward process that helps streamline the referral for imaging services. This guide provides step-by-step instructions to ensure you accurately complete all necessary sections of the form.
Follow the steps to complete the MRI referral form online.
- Press the ‘Get Form’ button to access the MRI referral form and open it for editing.
- Fill in the patient details section, including the patient's first name, surname, date of birth, and contact details. Specify if the patient is male or female, and provide their mobile and home telephone numbers along with an email address.
- Indicate the patient's payment method by selecting either 'Self-pay' or 'Insured'. Provide complete address details, including postcode, and any relevant insurance information such as the insurer's name and policy number.
- Complete the relevant clinical details section, providing information on the regions to be scanned, any additional requirements such as a 3T MRI or arthrogram, and whether Gadolinium contrast is required.
- Address the safety check questions, indicating 'Yes' or 'No' for each condition related to cardiac pacemakers, aneurysm clips, cochlear implants, renal impairment, recent surgery, metallic foreign bodies in the eye, breastfeeding, and pregnancy.
- Fill in the referring clinician's details, including their name, specialty, and how they would like to receive the report (email, post, or fax). If applicable, provide details for any other clinicians to whom the report should be sent.
- Sign and date the form to acknowledge understanding of the MRI contraindications and the implications of administering Gadolinium.
- Once the form is completed, save your changes. You can then download, print, or share the form as needed. Ensure to email it to booking@vistadiagnostics.co.uk or fax it to 0333 200 2065.
Complete your MRI referral form online today for efficient processing.
Related links form
If you have dental fillings and need an MRI, it is important to inform your healthcare provider when filling out the MRI referral form. Most dental fillings, particularly those made of composite materials, are safe for MRI. However, make sure you go over any concerns with your doctor to ensure a smooth MRI experience. They can guide you on what to include when completing the MRI referral form.
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