DOWNLOADABLE FORMS

If you have been scheduled for a MRI study at Open MRI Centers of Georgia, you may print the patient information and medical history forms directly from our website. Please have them fully completed and signed when you arrive for your MRI appointment. Additionally, there is a MAP with our address and phone numbers, in the event that you do not know where our facilities are located.

To view and print the forms, you must have Adobe Acrobat Reader. You can download it for free by clicking here.

Form 1: English Spanish
Authorization for treatment, assignment of medical benefits and payment responsibility.

Form 2: English Spanish
Authorization of insurance benefits.

Form 3: English Spanish
MRI Patient screening.

Form 4: English Spanish
Consent form and information release.

Form 5: English Spanish
Patient Information

NOTICE TO PATIENTS