In order to help protect our patients’ identities, effective May 1, 2009, all Austin Radiological Association’s patients will be asked to show a valid proof of ID, such as a Federal or State issued drivers license, military or government ID card or passport. All files are saved in Adobe pdf format and require Adobe Acrobat Reader to view. Click here to download a free copy of the viewer.
Downloadable Forms* (by exam)
*Please advise: These forms are not submitted electronically. You will need to please print, fill them out completely and bring them with you to your appointment.
Mammography
- Patient Information Form (English | Spanish)
- Mammography Worksheet (English | Spanish)
- Mammography Breast Implant Consent Form (women with breast implants) (English | Spanish)
- Pregnancy Release Form (women 55 and under) (English | Spanish)
Bone Densitometry
- Adult
- Patient Information Form (English | Spanish)
- Bone Density Patient Screening Questionnaire (English | Spanish)
- Pregnancy Release Form (women 55 and under) (English | Spanish)
- Pediatric
- Patient Information Form (English | Spanish)
- Pediatric Bone Density Patient Screening Questionnaire
- Pregnancy Release Form (Girls 10 years and older) (English | Spanish)
X-ray
- Patient Information Form (English | Spanish)
- Pregnancy Release Form (females between 10 and 55 years old) (English | Spanish)
IVP
- Patient Information Form (English | Spanish)
- Pregnancy Release Form (females between 10 and 55 years old) (English | Spanish)
- Patient History/Contrast (English | Spanish)
Ultrasound
MRI
- Patient Information Form (English | Spanish)
- Patient History/Contrast (English | Spanish)
- Metal Screening Form
- Pregnancy Release Form (females between 10 and 55 years old) (English | Spanish)
- Breast MRI Worksheet (MRI Breast Exams only)
CT /PET Scans/ Myleograms
- Patient Information Form (English | Spanish)
- Patient History/Contrast (English | Spanish)
- Pregnancy Release Form (females between 10 and 55 years old) (English | Spanish)
Fluoroscopy
- Patient Information Form (English | Spanish)
- Pregnancy Release Form (females between 10 and 55 years old) (English | Spanish)
Fluoroscopy – Hysterosalpingogram – HSG
- Patient Information Form (English | Spanish)
- Pregnancy Release Form (females between 10 and 55 years old) (English | Spanish)
- Hysterosalpingogram (HSG) Form
- Patient History/Contrast (English | Spanish)
Nuclear Medicine
- Patient Information Form (English | Spanish)
- Pregnancy Release Form (females between 10 and 55 years old) (English | Spanish)
Pediatric Sedations (In addition to exam forms listed above)
- Pediatric Sedation Form (English | Spanish)
- Pregnancy Release Form for Visitor (For any female visitor between 10 and 55 years old going in the exam room) (English | Spanish)
- Metal Screening Form for Visitor (If a patient is having an MRI and a family member would like to go in the exam room)
Interventional Exams
- EVLT Consults
- Patient Information Form (English | Spanish)
- Patient Consultation Form
- Interventional Consults
- Interventional Procedures
- Patient Information Form (English | Spanish)
- Interventional Radiology Consent Form
- Pregnancy Release Form (females between 10 and 55 years old) (English | Spanish)
