Get European Scanning Centre Request Form

Filling out the European Scanning Centre Request Form online is an important step for patients and referrers to facilitate medical imaging requests. This guide will provide clear instructions on each component of the form, ensuring a smooth and efficient completion process.

Follow the steps to complete your request form accurately.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. Fill in the patient name field with the full name of the individual requesting the scans.
3. Provide the date of birth of the patient in the designated section, ensuring the correct format is used.
4. Complete the address field, including any relevant contact information such as fax number and telephone number.
5. Indicate how the account will be settled by selecting the appropriate option: patient, doctor, insurance, or other.
6. Select the required CT investigation by checking the relevant box, ensuring that you specify all that apply, such as heart, abdomen, or brain.
7. For ultrasound requests, check the relevant box for the type of ultrasound required, including but not limited to abdominal aorta or neck.
8. Indicate the required MRI investigation by filling out the necessary details, including whether contrast is needed and any contraindications present.
9. If additional scans are necessary, specify the type of other scans by checking the boxes provided and adding relevant clinical details.
10. Provide information about any known allergies in the allergies section to ensure patient safety.
11. Once all fields are filled out, review the information for accuracy and completeness.
12. After ensuring that all required information is correct, users can save changes, download, print, or share the completed form as needed.

Complete your European Scanning Centre Request Form online today for a streamlined submission process.