Patient

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


Individual Forms


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

High Tech Imaging Center is an independent medical imaging facility conveniently located just off I-85 at Forest Avenue, across from CVS Pharmacy and inside Neuro Spine Institute.

Contact Us


Address:
1510 Forest Avenue - Suite C
Montgomery, AL 36106
Phone: (334) 265-7213
Email: resmaili@sbcglobal.net
Fax: (334) 241-8844