Pre-Visit Forms

Below are the necessary patient forms that you will need for your visit to High 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 High Tech Imaging Center at (334) 265-7213.

All Forms

Download

Referal Form

Download

Authorization For Use and Disclosure of Protected Health Information

Download

Consent For Intravenous MRI Injection

Download

CT Questionaire-Consent For Intravenous Injection

Download

MRI Patient History-Safety Screening

Download

Notice of Privacy Practice Acceptance

Download

Patient Information

Download

Patient Statement of Pregnancy-Nursing Condition

Download

Privacy Policy HIPPA Disclaimer

Download