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Melbourne Radiology Clinic

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Mar 31st
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MRI Consent Form and Safety Questionnaire

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This information is for patients of Melbourne Radiology Clinic who intend to undergo a test known as an MRI (Magnetic Resonance Imaging) scan.

An MRI scanner uses a powerful magnet and radiowaves to produce superbly detailed views of the human body, particularly soft tissues, such as the brain, spinal cord and muscles. Unlike many other imaging tests, MRI does not use radiation. Though some discomfort may occur from having to lay still, MRI is otherwise a painless procedure and typically takes approximately 20 minutes to perform.

A high field magnet, as used in MRI may have serious consequences in certain patients, and as such, we need you to answer some questions.

Download PDF Information Sheet and Consent Form Melbourne Radiology Clinic - MRI Consent Form & Safety Questionnaire [March 2016]

 

Please read the information and questions carefully and answer them to the best of your knowledge.
If you do not understand a question, please do not hesitate to ask our technician or speak to our doctor.

MRI Consent Form & Safety QuestionnaireThree questionnaires are contained within the PDF document available above. These include:

1. MRI SAFETY QUESTIONNAIRE – this determines whether it is safe for you to have an MRI scan.

2. MRI CONTRAST STUDY QUESTIONNAIRE – this is an information sheet and consent form should you require an injection of MRI contrast / dye (Gadolinium). The risks and benefits of this injection are discussed.

3. MRI CLINICAL INFORMATION QUESTIONNAIRE – this questionnaire is aimed at providing Melbourne Radiology Clinic with as much information as possible about your condition and why you are having an MRI scan. It is designed to assist our doctor in providing an accurate and relevant interpretation of your examination.

We appreciate you taking the time to read the downloadable Information Sheet and complete these questionnaires.

Please note that your details can be entered directly into the PDF form, saved and printed to bring with you to your MRI appointment at Melbourne Radiology Clinic.

For more information read:
Melbourne Radiology Clinic - Patient Fact Sheet on MRI

For more information read:
Melbourne Radiology Clinic - Patient Fact Sheet on MRI - Children under 16 - Information for Parents

Last Updated ( Wednesday, 30 March 2016 14:28 )  
 
MEDICAL DISCLAIMER The Melbourne Radiology Clinic web site is not intended as a substitute for your own independent health professional’s advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider within your country or place of residency with any questions you may have regarding a medical condition. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second medical opinion.