Skip to main content
McGovern Medical School LogoMcGovern Medical School
Department of Diagnostic and Interventional Imaging
  • About
    • Message from Chair
    • Contact
    • Staff Physicians
    • Staff
    • Careers
  • Subspecialties
    • Abdominal Imaging
    • Cardiothoracic
    • Emergency
    • Interventional Radiology
    • Mammography
    • Musculoskeletal Imaging
    • Neuroradiology
    • Nuclear Medicine and Molecular Imaging
    • Pediatrics
  • Education
    • Diagnostic Radiology & Integrated IR Residency Programs
    • Medical Physics Residency
    • Fellowships
    • Medical Student
    • Conference Schedules
  • Faculty
    • Faculty
    • Presentations & Handouts
  • Research
    • MR Research Group
    • Research Faculty & Staff
    • Research Resources
    • Funding Opportunities
    • Forms
    • Currently Enrolling Clinical Research Studies
  • UT Health MRI
    • UT Health MRI Center
    • Patient Resources
    • Provider Resources
  • Resources
    • Ask an Expert
    • News
    • COVID
    • Calendar
  • Give Now
  • UT Health MRI Center
  • Patient Resources
  • Provider Resources

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

Department of Diagnostic and Interventional Imaging
at McGovern Medical School

Radiology

  • Ask the Imaging Experts
  • Staff
  • Careers
  • Visit us on Facebook

Helpful Links

  • Diagnostic Radiology & Integrated IR Residency Programs
  • Fellowships
  • Medical Student
  • Conference Schedules
McGovern Medical School Logo
  • McGovern Medical School Facebook Page
  • McGovern Medical School Twitter Page
  • McGovern Medical School Instagram Page
  • McGovern Medical School YouTube Page
  • Contact Us
  • Medical School IT (MSIT)
  • Campus Carry
  • Careers
  • Emergency Info
  • University Website Policies
© Copyright 2008-Present | The University of Texas Health Science Center at Houston (UTHealth)