Medical Forms

For your convenience, Greensboro Imaging has a dedicated page for many medical forms and educational materials relating to your imaging procedure. Before your appointment at Greensboro Imaging, you may wish to download, print and complete medical forms and review educational materials. A staff member will assist you in selecting the forms you will need to complete and bring to your appointment as well as which educational materials may be helpful. Completing medical forms in the privacy of your home can save you time and effort when you arrive. Be sure to bring the completed forms with you to your appointment. If you have any questions, please contact Greensboro Imaging at (336) 433-5000(336) 433-5000.

All Patients

Patient Registration [PDF]
Notice of Privacy Practices [PDF]
Receipt of Privacy Practices Notice [PDF]
Financial Policy [PDF]
Financial Aid Form [PDF]

Breast Center

Medical Records Release [PDF]

CT Scan Patients

CT Information Sheet [PDF]
DXA Bone Density Patients Bone Density Screening [PDF]
DXA Release [PDF]
Release of Information, Bone Density [PDF]

Interventional Radiology Patients

Interventional Radiology Procedures [PDF]

Mammogram Patients

Release of Information, Mammography [PDF]
Breast Self-Exam Instructions [PDF]

MRI Patients

MRI Brain History [PDF]
MRI Upper Extremity History [PDF]
MRI Lower Extremity History [PDF]
MRI Spine History [PDF]
Breast MRI History [PDF]
Chest, Abdomen and Pelvis MRI History [PDF]

Spine Procedures

Informed Consent [PDF]
Policy Regarding Drivers [PDF]
Spinal Post-Procedure Instructions [PDF]
Spinal Discogram Post-Procedure Instructions [PDF]
Spine Information Booklet [PDF]

Stereotactic Breast Biopsy Patients

Post-Biopsy Instructions [PDF]

Vein Treatment Patients

Patient Venous History [PDF]
Informed Consent [PDF]
Endovascular Consent [PDF]
Pre-Procedure Instructions [PDF]
Post-Procedure Instructions [PDF]
Varicose Vein Therapy FAQs [PDF]

Virtual Colonoscopy Patients

Virtual Colonoscopy Request [PDF]
Virtual Colonoscopy Waiver of Liability [PDF]

Wire Localization

Wire localization Instructions [PDF]