PREPARING FOR YOUR SCAN CHECKlist
Please print and sign the Checklist, and bring it with you to your appointment.
Please print and complete the additional required forms below prior to your appointment. Having this paperwork done ahead of time will greatly expedite your appointment time, and we all know how precious time is!
Required privacy forms
- Notice of Privacy Practices
- Authorization to Use or Disclose Protected Health Information
- Request for Alternative Communications
- Client Medical History (required)
- Client Information (required)
- Breast Questionnaires (required for breast scans)
- Full Body Study Questionnaire
- Lower Body Study Questionnaire
- Upper Body Study Questionnaire