On submitting this form please be advised that one of our dedicated MRI receptionists will be in contact with you to arrange a date and time for your examination.
It is important that you answer these questions accurately as it directly relates to your safety.
If you are unsure on any of these questions they will be clarified upon booking.
Your information is sent directly and securely to South East Radiology. We take confidentiality very seriously and it is important to note that your information is entered into our patient information system. This form is not stored.