Provider Resources

The following information are for providers interested in referring their patients to our 3T MRI Center.

UT MRI Physician Order final Form

UT 3T MRI Allscripts ordering process

Family Screening Form English (Research and Clinical)

MR Patient Procedure Screening Form-English 2016

Patient Screening Forms Spanish- (Research and Clinical)

Breast Feeding and contrast agent (Research and Clinical)

Contrast Consent Form (Research and Clinical)

Pregnancy Consent Form

To request forms listed above please email:

Vips Patel-MRI Tech and Facility Manager 713-500-6915

Kurt Simon- Administrative Assistant /Patient Services 713-500-6916