Patient Forms
Advanced Medical Imaging — Seminole, FL
Complete your forms online before your appointment to save time at check-in. Click any form below to fill it out digitally, or print and bring it with you.
Before Your Appointment
- •Complete forms at home to save time at check-in
- •Bring completed forms + photo ID + insurance card to your appointment
- •Questions? Call us at (727) 398-5999 — we're happy to help
- •Forms can also be completed at our front desk upon arrival
All Forms
Patient Registration Form
New patient? Complete this form before your first visit to save time at check-in. Includes demographic, insurance, and emergency contact information.
MRI Safety Screening Form
Required for ALL MRI and Open MRI patients. Screens for implants, devices, and other metal that could be affected by strong magnetic fields.
Medical History Form
Helps our radiologists understand your health background and ensure the safest, most accurate imaging study for you.
Insurance & Financial Responsibility
Review our financial policies, authorize insurance billing, and understand your payment responsibilities before your appointment.
HIPAA Privacy Acknowledgment
Acknowledges receipt of our Notice of Privacy Practices, explaining how we use and protect your health information.
Contrast Media Consent Form
Required if your exam involves IV contrast (dye). Covers risks, allergies, kidney function, and your informed consent.
Need Help?
Our team is happy to assist you with any form. Call us and we can walk you through it over the phone or mail you a paper copy.
Ready to Schedule?
Same-day appointments available for CT and X-Ray. Call or book online.