EVER HAD METAL REMOVED FROM YOUR EYE(S)

Yes
No

EVER WORKED WITH METAL (I.E. WELDING, GRINDING, ETC)

Yes
No

CARDIAC PACEMAKER

Yes
No

ANEURYSM CLIP(S)

Yes
No

IMPLANTED CARDIAC DEFIBRILLATOR

Yes
No

NEUROSTIMULATOR

Yes
No

BREAST TISSUE EXPANDER

Yes
No

ANY TYPE OF BIOSTIMULATOR

Yes
No

TYPE

IMPLANTED INSULIN PUMP

Yes
No

PACING WIRES, COCHLEAR IMPLANT, OTHER

IMPLANTED INSULIN PUMP

Yes
No

ANY TYPE OF ELECTRONIC, MECHANICAL, OR MAGNETIC IMPLANTS

Yes
No

TYPE

IMPLANTED DRUG INFUSION PUMP

Yes
No

ANY TYPE OF FOREIGN BODY, SHRAPNEL OR BULLET

Yes
No

ANY TYPE, IF IMPLANT, HELD BY MAGNET

Yes
No

ANY IMPLANTED ORTHOPEDIC ITEMS (I.E. PINS, SCREWS, PLATES)

Yes
No

ARTIFICIAL LIMB OR JOINT

Yes
No

ANY TYPE OF SURGICAL CLIP OR STAPLE(S)

Yes
No

Halo Vest or metallic cervical fixation device

Yes
No

Are you pregnant?

Yes
No

Swan-Ganz catheter

Yes
No

Heart valve

Yes
No

Any type of ear implant

Yes
No

Penile prosthesis

Yes
No

Dentures

Yes
No

Diaphragm

Yes
No

IUD

Yes
No

Pessary

Yes
No

Wire mesh

Yes
No

Attached weights of any kind (i.e. ankle, body)

Yes
No

Body piercing

Yes
No

Diabetes

Yes
No

Tattoos of any type (a small percentage of patients with tattoos experience transient skin irritation in association with MRI)

Yes
No

Kidney problems (Renal failure, Hypertension, One Kidney)

Yes
No

MRI (English)

MRI Screening - English

Hours of Operation

Services

Services

Information