Patient Forms

How do I know which form(s) I should complete?

All new patients OR patients that have not had an exam at URG in the last 6 months must complete the Medical History Questionnaire. Depending upon the exam ordered, you may also need to complete 1 or more of the following questionnaires:

• If you are scheduled for a MRI — You must also complete the MRI Screening questionnaire.
• • If you are scheduled for a MRI or a CT Scan of the Brain or Spine, Please also complete the MRI/CT Neuro form.
  • If you are scheduled for a MRI or a CT scan of a joint (knee, hip, elbow, etc), Please also complete the MRI/CT MSK questionnaire.
  • If you are a female & scheduled for a MRI of the Pelvis, Please also complete the MRI Female Pelvis questionnaire.
  • If you are scheduled for a MRI of Prostate, please also complete the MRI Prostate questionnaire.
• If you are scheduled for a CT Scan of the Sinus, please also complete the CT Scan Sinus form.
• If you are scheduled for a Dexa scan, please also complete the Dexa questionnaire.

* Patients scheduled for other exams not listed above (Mammo, Ultrasounds, Xray, etc) only need to complete the Medical History questionnaire.

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