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Weill Cornell Imaging at NewYork-Presbyterian

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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)

WCM Survey Icon (3) 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.  

WCM Survey Icon (3) CT Cardiovascular Form 

DEXA

WCM Survey Icon (3) DEXA Form  

FLUOROSCOPY

WCM Survey Icon (3) Fluoroscopy Form 

LUNG SCREENING

WCM Survey Icon (3) Lung Screening Form 

MAGNETIC RESONANCE IMAGING (MRI)

WCM Survey Icon (3) 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.  

WCM Survey Icon (3) MRI Breast Form 
WCM Survey Icon (3) MRI Cardiovascular Form 
WCM Survey Icon (3) MRI Gynecologic Form 
WCM Survey Icon (3) MRI Prostate Form  

MAMMOGRAPHY

WCM Survey Icon (3) Mammography Form 
WCM Survey Icon (3) Breast Biopsy Form 

POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY (PET/CT)

WCM Survey Icon (3) PET/CT Form 

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

WCM Survey Icon (3) PET/MRI Form 

ULTRASOUND

WCM Survey Icon (3) Ultrasound General Form 

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

WCM Survey Icon (3) Ultrasound Gynecologic Form 

X-RAY

WCM Survey Icon (3) 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.

PDF icon CT General Safety Form 

PDF icon CT Cardiovascular Form 

PDF icon DEXA Form 

PDF icon Fluoroscopy Form 

PDF icon Lung Screening Form 

PDF icon MRI General Safety Form 

PDF icon MRI Breast Form 

PDF icon MRI Cardiovascular Form 

PDF icon MRI Gynecologic Form 

PDF icon MRI Prostate Form 

PDF icon Mammography Form 

PDF icon Breast Biopsy Form

PDF icon PET/CT Form 

PDF icon PET/MRI Form 

PDF icon Ultrasound General Form 

PDF icon Ultrasound Gynecologic Form 

PDF icon X-ray Form

Weill Cornell Imaging at NewYork-Presbyterian

1305 York Avenue, 3rd Floor
New York, NY 10021

1283 York Avenue, 7th Floor
New York, NY 10065

520 East 70th Street,
Starr Pavilion, Ground Floor

New York, NY 10021

425 East 61st Street, 9th Floor
New York, NY 10065

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New York, NY 10024

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Ground Floor

New York, NY 10038

416 East 55th Street
New York, NY 10022