MRI Safety Checklist

Please complete this checklist before attending for your MRI appointment.

Completing the safety checklist online will help streamline your appointment. If you cannot complete the checklist on line a paper version can be completed on site immediately prior to your appointment time.

Step 1

Personal information

This information is required to ensure your safety for the MRI examination.

First Name

Surname

Address

Date of birth (dd/mm/yyyy)

Height (cm)

Weight (kg)

Home Phone

Mobile

Have you had any imaging on the area of concern in the past?

At what hospital or practice was it performed?

Radiology SA

MRI Safety Checklist

Personal information

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