info@medtechimagingcenter.net

Phone: (334)-358-1666 Fax: (334)-777-1811

Med Tech Imaging Center
Med Tech Imaging Center
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    • Home
    • Review US!
    • Physicians
      • Portal
      • Referral Form
      • CPT CODE
    • Services
    • Patient
      • Patient Portal
      • New Patient FAQ
      • Pre-Visit Forms
      • ApprovedInsuranceProvider
      • New Patient Information
    • Skeleton Diagram
      • MRI Skeleton Diagram
      • CT Skeleton Diagram
    • About US
      • Our Values
      • Our Office
      • Letter of Protection
      • WALK-IN
    • Contact us
    • Employee of the Month
  • Home
  • Review US!
  • Physicians
    • Portal
    • Referral Form
    • CPT CODE
  • Services
  • Patient
    • Patient Portal
    • New Patient FAQ
    • Pre-Visit Forms
    • ApprovedInsuranceProvider
    • New Patient Information
  • Skeleton Diagram
    • MRI Skeleton Diagram
    • CT Skeleton Diagram
  • About US
    • Our Values
    • Our Office
    • Letter of Protection
    • WALK-IN
  • Contact us
  • Employee of the Month

Pre-Visit Forms

Please Complete the Following Forms Before Your Visit

 Below are the necessary patient forms that you will need for your visit to Med Tech Imaging Center. 


If you are scheduled to have a procedure performed or you have been asked to complete one of these forms by a member of our staff, please download and print the document below. Complete the form by hand and bring it with you to your appointment. 


If you have any questions, please contact Med Tech Imaging Center at (334)-358-1666. 

REFERRAL FORM (pdf)Download
AuthorizationForUse/DisclosureofProtectedHealthInformation (pdf)Download
Consent For Intravenous MRI Injection (pdf)Download
CT Questionaire-Consent For Intravenous Injection (pdf)Download
MRI Patient History-Safety Screening (pdf)Download
Notice of Privacy Practice Acceptance (pdf)Download
Patient Information (pdf)Download
Privacy Policy HIPPA Disclaimer (pdf)Download
Bone Density Questionnaire (pdf)Download
MEDTECH - ALL FORMS (pdf)Download

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CONTACT DETAILS

102 Medical Center Drive, Suite B Prattville, Alabama 36066

PH:(334)-358-1666

FX:(334)-777-1811

info@medtechimagingcenter.net

www.medtechimagingcenter.net


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