Capturing the right information is more than paperwork; it’s how we prioritize your well-being and preferences. It helps us involve, educate and respect our patients. We want to manage your appointment effectively, and we value your time and safety. You can help by printing and completing the relevant patient forms before your arrival.
Medical Record Release Form
New Patient Forms
- Patient Registration Form - Lancaster Imaging
- Patient Registration Form – Elite Advanced Imaging
- Patient Registration Form – Victor Valley Advanced Imaging
- Patient Registration Form – Victor Valley Hesperia
- Patient Registration Form – Victorville Open MRI
- Patient Registration Form – Heritage Phelan Office
- Patient Registration Form – Heritage Victor Valley
- Patient Registration Form – Main Street Imaging
CT Forms
- CT IV Contrast Informed Consent Form
- CT Patient History Form English
- Virtual Colonoscopy Patient History Form
MRI Forms
Mammography Forms
DEXA Patient History Form
PET/CT Forms
- PET/CT Amyloid Brain-Neuro Questionnaire
- PET/CT Amyloid Brain Questionnaire
- PET/CT FDG Brain Questionnaire
- PET/CT FDG Brain-Neuro Questionnaire
- PET/CT FDG Scan Questionnaire
- PET/CT NAF Scan Questionnaire
- PET/CT NAF FDG Consent Form
Todas las formas de la lengua española
- Formulario de Registro del Paciente – Lancaster
- Formulario de Registro del Paciente – Elite Advanced Imaging
- Formulario de Registro del Paciente – Victor Valley Advanced Imaging
- Formulario de Registro del Paciente – Victor Valley Hesperia
- Formulario de Registro del Paciente – Victorville Open MRI
- Formulario de Registro del Paciente – Heritage Phetan Office
- Formulario de Registro del Paciente – Heritage Victor Valley
- Formulario de Registro del Paciente – Lancaster Imaging
- Formulario de Registro del Paciente – Main Street Imaging
- Informacion Del Paciente
- Breast History Spanish
- Consentimiento Informativo, Examen MRI Del Seno
- Historial Del Paciente De Bone Density
- Historial Del Paciente, CT
- Historial Del Paciente, Mammography
- Historial Del Paciente, MRI Del Seno
- Historial De Cirugia Del Seno, MRI Del Seno
- Historial Del Paciente, Virtual Colonoscopy
- Historial De MRI y Forma De Consentimiento
- PET/CT FDG Brain Questionnaire (Spanish)
- PET/CT FDG Brain-Neuro Questionnaire (Spanish)
- PET/CT NAF Scan Questionnaire (Spanish)
- Tarjeta de Comentarios
