Forms For Patients

PATIENT INFORMATION FORM

Patients, please download and fill out this form prior to coming in for your appointment. You can bring it with you or fax it to (626) 821-3460.

MRI PATIENT QUESTIONNAIRE

MRI patients, download and complete this form prior to your appointment to save time. Bring it with you or fax it to (626) 821-3460.

PATIENT QUESTIONNAIRE

Patients visiting Arcadia Radiology will need to fill out the HITECH Act required Patient Questionnaire each time they arrive for their appointment. Bring it with you or fax it to (626) 821-3460.

AUTHORIZATION FOR USE OR DISCLOSURE OF PROTECTED HEALTH INFORMATION

Patients, please use this form when you wish to have your protected health information released to you or another party. You may bring this form to our office or fax it to (626) 821-3460.