Pre-Registration

Fill out these forms before your visit, to speed up your waiting time. Bring them with you, and your registration will be nearly complete.

• Acknowledgement of receipt of Joint Privacy

Health Records

To order your health records, complete this form.

• Authorization to Use and Disclose Health Information
• Request for Access to or Copies of Protected Health Information

Financial Aid Form

If you require financial aid, please complete these forms and bring them with you to your appointment.

• Financial Aid Agreement and Consent
• Advance Beneficiary Notice

Patient Information

Here are a couple documents we thought you might be interested in:

• Patient Financial Assistance Programs
• Brochure: Cardiac Computed Tomography Information
• Our locations and directions
• Our hours of operation
• Finding your way at Riverbend

Pregnancy Waiver

If you are pregnant and require an MRI, please complete this form, and bring it with to your appointment.

• Pregnancy Waiver