Patient Forms

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Welcome to Radiology Consultants Little Rock. For your convenience, you will find forms for Medical Towers #1 Imaging Center, as well as Baptist Health MRI Center.
  • Please print and fill out all applicable forms
  • BRING completed with you to your appointment. Present completed forms to the front desk when you arrive for your first office visit
  • Categories noted with a red asterisk * indicate forms required by all patients

Radiology Consultants Imaging Center
Medical Towers #1


 

Note:  Patient Registration Form, Privacy Practices Explained Pamphlet and Privacy Practices – Receipt of Form are required to be completed by all patients with appointments at Radiology Consultants’ Imaging Center.

 



 

 

Baptist Health MRI Centers

Required Forms  *

E-16 Pre-MRI Procedure Screening Form REQUIRED; Bring completed form to appointment

E-17 MRI Patient Safety Screening REQUIRED; Bring completed form to appointment

MRI_Patient Intake Sheet REQUIRED; Bring completed form to appointment

General History Sheet REQUIRED; Bring completed form to appointment

 

Specific Body Section Forms

Ankle / Foot History Sheet

Back History Sheet

Brain History Sheet

Breast History Sheet

Elbow History Sheet

Knee History Sheet

MRCP – Magnetic Resonance Cholangiopancreatography History Sheet

Prostate History Sheet

Shoulder History Sheet

Wrist History Sheet