Exam Forms

All forms should be completed in advance of your appointment. Please follow the links below to access the appropriate form required for your upcoming appointment. If you need assistance filling out the form, please contact our Access Center at (212) 746-6000.

COMPUTED TOMOGRAPHY (CT)

 CT General Safety Form 

If you are having a Cardiovascular CT (CT of the heart), please complete the CT Cardiovascular Form in addition to the general CT safety form.  

 CT Cardiovascular Form 

DEXA

 DEXA Form  

FLUOROSCOPY

 Fluoroscopy Form 

LUNG SCREENING

 Lung Screening Form 

MAGNETIC RESONANCE IMAGING (MRI)

 MRI General Safety Form 

If you are having a Breast, Cardiovascular (MRI of the heart), Gynecologic or Prostate MRI, please complete the appropriate specialized form in addition to the general MRI safety form.  

 MRI Breast Form 
 MRI Cardiovascular Form 
 MRI Gynecologic Form 
 MRI Prostate Form  

MAMMOGRAPHY

 Mammography Form 
 Breast Biopsy Form 

POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY (PET/CT)

 PET/CT Form 

POSITRON EMISSION TOMOGRAPHY/MAGNETIC RESONANCE IMAGING (PET/MRI)

 PET/MRI Form 

ULTRASOUND

 Ultrasound General Form 

If you are having a Gynecologic (Pelvic) Ultrasound exam, please complete the Ultrasound Gynecologic Form instead of the general form.   

 Ultrasound Gynecologic Form 

X-RAY

 X-ray Form 

PDF Forms

The above forms are also available in PDF. Please follow the appropriate link below to download, complete, and e-sign the PDF form(s) using Adobe® Acrobat® Reader. Email the completed form(s) as an attachment to wcinyppreregistration@med.cornell.edu prior to your appointment. If you do not have Adobe, download it or visit adobe.com for more information.

 CT General Safety Form 

 CT Cardiovascular Form 

 DEXA Form 

 Fluoroscopy Form 

 Lung Screening Form 

 MRI General Safety Form 

 MRI Breast Form 

 MRI Cardiovascular Form 

 MRI Gynecologic Form 

 MRI Prostate Form 

 Mammography Form 

 Breast Biopsy Form

 PET/CT Form 

 PET/MRI Form 

 Ultrasound General Form 

 Ultrasound Gynecologic Form 

 X-ray Form