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 Safety Form 

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

 Cardiovascular CT 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  

For a video overview of the MRI experience, please click here or visit the video library page. 

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