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Please complete the following Safety Questionnaire.
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    Please removed magnetic eyelashes prior to your appointment.

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    The American Academy of Radiology recommends that you express and discard your breast milk for 24 hours post MRI procedure, if you are receiving MRI contrast.

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    Remove all metallic objects before entering the MR environment or MR system room including hearing aids, beeper, cell phone, keys, eyeglasses, hair pins, barrettes, jewelry (including body piercing jewelry), watch, safety pins, paperclips, money clip, credit cards, bank cards, magnetic strip cards, coins, pens, pocket knife, nail clipper, steel-toed boots/shoes, and tools. Loose metallic objects are especially prohibited in the MR system room and MR environment.
    Please consult the MRI Technologist or Radiologist if you have any question or concern BEFORE you enter the MR system room.

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    WARNING: Certain implants, devices, or objects may be hazardous to you in the MR environment or MR system room. Do not enter the MR environment or MR system room if you have any question or concern regarding an implant, device, or object.

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  • 46

    Remove all metallic objects before entering the MR environment or MR system room including hearing aids, beeper, cell phone, keys, eyeglasses, hair pins, barrettes, jewelry (including body piercing jewelry), watch, safety pins, paperclips, money clip, credit cards, bank cards, magnetic strip cards, coins, pens, pocket knife, nail clipper, steel-toed boots/shoes, and tools. Loose metallic objects are especially prohibited in the MR system room and MR environment.
    Please consult the MRI Technologist or Radiologist if you have any question or concern BEFORE you enter the MR system room.

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  • 47

    I attest that the above information is correct to the best of my knowledge. I have read and understand the entire contents of this form and have had the opportunity to ask questions regarding the information on this form.

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