MRI Screening Form

The Rotman MRI Participant Safety Screening Form is available for Download here:

Downloads

Our MRI Screening Form can be printed and filled out by hand, or filled out electronically with Adobe Reader and then printed. You may send it to participants to complete in advance if they are able, or have them complete it on site. Please allow time to complete the form prior to arrival at the MRI if you are having them complete the form on site. Also take into consideration the various screening form questions during your initial subject screening process. If your subject completes the form on site and is not eligible to be scanned, your reservation will be subject to normal cancellation fees. Please note that the MRI Screening Form will contain sensitive PHI when complete. Treat it using the necessary measures to maintain privacy and confidentiality. If completed in advance, note that the date on the top of the screening form is the scan date.