Order MRI Scan

Select Scan Centre:
Alliance Medical Epsom, KT18 7LX Alliance Medical Marylebone, WIU 2HX Canary Wharf, 3T, E14 4HA County Hospital Louth, LN11 OEU Enfield MRI Centre, EN2 8JL Leeds Community MRI Service, Oulton, LS26 8NX Orpington 3T, BRS 3TW Pall Mall Hospital, Newton Le Willows, WA12 OJJ Penrith Football Club, CAI1 SUA Preston Community MRI, PR4 0AP Sleaford Community MRI, NG34 7ER Spalding Community Hospital, PE11 3DT Taunton Diagnostic Centre, TA1 2PX Turner Diagnostic Centre, CO4 SJL Vitalscan, MK9 1FH Wythenshaw Community MRI. Manchester, M22 4DB Wythenshawe Hospital, Manchester, M23 9LT

Gender:
Male Female

Reason For Scan:

Has the patient had any previous surgery?
Yes No

Has the patient had any previous imaging?
Yes No

If yes, was this previous imaging of the same area of the body?
Yes No

Does the patient have any allergies?
Yes No

Does the patient suffer from claustrophobia?
Yes No

Does the patient suffer from epilepsy?
Yes No

Has the patient had any operations on their brain?
Yes No

Has the patient has any operations on their spine?
Yes No

Has the patient had any operations in the last 6 weeks?
Yes No

Has the patient had any injuries or operations involving metal? Or do you believe they have any metal fragments in their body?
Yes No

Does the patient wear a medicine patch e.g. nicotine, angina, contraception?
Yes No

Does the patient suffer from regular fits/blackouts?
Yes No

Does the patient have a cardiac (heart) pacemaker or capsule endoscopy?
Yes No

Does the patient have an aneurysm clip in their brain
Yes No

Does the patient have a programmable hydrocephalus shunt?
Yes No

Does the patient have a cochlear implant?
Yes No

Does the patient suffer from asthma attacks or hay fever?
Yes No

Is the patient pregnant?
Yes No

Does the patient weight over 18 stone (114kg)?
Yes No

Is the patient over 6 foot 4 inches tall?
Yes No

GP Details