Patient Forms

Patient Medical Records

You can stop by our office Monday-Friday to pick up the Disc between 09:00 am to 04:30 pm.

AIC Prep Instructions -

NOW OPEN 7AM – 5:30PM MON – FRI FOR ALL SERVICES BY APPOINTMENT ONLY

Download PDF New Prep Instructions and Map (File size: 626,335 bytes) Note: The request form is in PDF format and requires Adobe Acrobat Reader. If you don't have Acrobat Reader you can download it from www.adobe.com.

New Script Pad

Download PDF AIC script 2018 (File size: 1,449,809 bytes) Note: The request form is in PDF format and requires Adobe Acrobat Reader. If you don't have Acrobat Reader you can download it from www.adobe.com.

New Patient Form

Download PDF New Patient Form Page 1 (File size: 225,923 bytes) Note: The request form is in PDF format and requires Adobe Acrobat Reader. If you don't have Acrobat Reader you can download it from www.adobe.com.

Dexa Form

Download PDF DEXA FORM (File size: 230,680 bytes) Note: The request form is in PDF format and requires Adobe Acrobat Reader. If you don't have Acrobat Reader you can download it from www.adobe.com.

X-Ray Form

Download PDF XRAY FORM 18 (File size: 227,645 bytes) Note: The request form is in PDF format and requires Adobe Acrobat Reader. If you don't have Acrobat Reader you can download it from www.adobe.com.

CT/PET Form

Download PDF CT Questionnaire 18 (File size: 228,314 bytes) Note: The request form is in PDF format and requires Adobe Acrobat Reader. If you don't have Acrobat Reader you can download it from www.adobe.com.

Auto Accident/Slip and Fall Paperwork

Download PDF PIP PAPERWORK WITH MCW AND ABN (File size: 595,801 bytes) Note: The request form is in PDF format and requires Adobe Acrobat Reader. If you don't have Acrobat Reader you can download it from www.adobe.com.

HIPPA (PRIVACY POLICY)

Download PDF HIPAA AND AUTHORIZATION (File size: 134,121 bytes) Note: The request form is in PDF format and requires Adobe Acrobat Reader. If you don't have Acrobat Reader you can download it from www.adobe.com.

MRI and Hippa

Download PDF MRI and Hippa (File size: 222,190 bytes) Note: The request form is in PDF format and requires Adobe Acrobat Reader. If you don't have Acrobat Reader you can download it from www.adobe.com.

If you are unsure what to print, Kylie will be more than happy to assist you if you e-mail her at kbarnes@advancedimagingconcepts.com