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Open and Upright MRI scan

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NHS GP

It is a requirement that we communicate results to your NHS GP in order that they can make recommendations about your future care. By submitting this form you acknowledge and accept that:

- A copy of your report will be sent to your GP
- Neither the radiographer who has conducted the scan/form or the radiologist reporting it can discuss the findings of the scan with you.

If known
Do you have or have you ever had a cardiac pacemaker or internal defibrillator fitted to your heart?
Have you ever had any operations or procedures carried out on your head, heart, eyes or ears?
Have you had any operations or procedures carried out on any blood vessels in your body, such as aneurysm or vascular clips?
Do you have any implants in, or medical devices attached to your body?
Have you ever had a penetrating injury to your eyes involving metal?
Have you ever suffered a shrapnel injury (bomb blast or gunshot)?
Have you had any surgery or procedures carried out in the past 6 weeks?
Do you have a history of cancer or a long term medical condition related to the area to be scanned?
For female patients: Is there any possibility that you are or may be pregnant?
Do you experience claustrophobia, extreme anxiety, or inability to lie flat?