Scheduling and Patient Forms
Your Visit
Your physician or health care provider will order your MRI scan and/or PET/CT study through Oregon Advanced Imaging. Your provider will provide us signed orders listing the type of procedure, area to be scanned, and clinical information necessary for an accurate, high quality diagnostic study. Once the orders are received, we will contact you to set up your appointment.
If you have not received a call from our offices within two working days, please contact our Oregon Advanced Imaging Scheduling Department at 541-608-0350.
Patient Forms
As a convenience to our patients, we have provided our most utilized patient forms in PDF format. You will need Adobe Acrobat Reader to view and print these forms. If you do not have this program, you may download it for free here. Please click on the name of the form below to open and print it.
You will need Adobe Acrobat Reader to view and print the PDF forms. If you do not have this program, you can download it for free.
MRI Safety Screening Patient (pdf)
This form is completed by all patients scheduled for an MRI. Want to know more about this exam? Please visit our MRI page.
MRI Safety Screening Visitor (pdf)
If you’d feel more comfortable with a friend or family member being in the MRI room with you, they will need to fill out this form.
Authorization for Consent (pdf)
OAI will bill your insurance company. This form explains the billing and communication process with your insurance company and/or referring medical office.
Breast Imaging Questionnaire (pdf)
This form is completed by all patients scheduled for a Breast MRI. Want to know more about this exam? Please visit our Breast MRI page.
Lactating Patients having an MRI (pdf)
This form is completed by all lactating patients scheduled for a Breast MRI.
Medical Records
Medical Record Release Authorization (pdf)
Your original exam records are confidential and remain safely stored at Oregon Advanced Imaging for 10 years. Should you require your records to be sent to another physician or provider, please download and print our Medical Record Release Authorization form. Complete the form and send to the address or fax listed below.
CD Requests
Oregon Advanced Imaging will provide the patient with one paper copy of the Report as a courtesy, and will provide CD’s upon request for $10.00 each. Please download, print, and complete our Medical Record Release Authorization form and send to the address or fax listed below. Be sure to indicate where the CD should be mailed and include payment of $10.00 for each CD. Please note, there may be an additional charge for shipping.
Fax: (541)773-7009
Oregon Advanced Imaging
881 O’Hare Parkway
Medford, OR 97504
Questions
If you have any questions, please give our office a call. We are happy to help!
541-608-0350
800-462-1098