Regional Medical Imaging
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Patient Forms

To ensure that we have all of the medical and personal information we need to achieve the highest level of diagnostic accuracy, communicate effectively with your doctor, and make your visit go as smoothly, comfortably, and efficiently as possible, we may ask you to complete one or more forms before your visit.

For your convenience, we have provided a downloadable, Adobe PDF version of our new patient information form. We recommend that you download and print this form, fill it out in the privacy and comfort of your home, and bring it with you when you come in for your visit. Completing this form prior to your appointment will expedite your visit

New Patient Info Form

Request an Appointment

Film Pick-up Request

 

Regional Medical Imaging, P.C. | 3346 Lennon Road, Flint, Michigan, 48507 | (810) 732-1919
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