Authorization for Records Release

"*" indicates required fields

06/20/2025
Name*
MM slash DD slash YYYY
Consent*

Main Office:
PALM HARBOR MRI
32615 US Hwy 19 North
Palm Harbor, FL 34684
Phone: 727.787.6900
Fax: 727.216.4789

FACILITIES

Palm Harbor MRI
Palm Harbor MRI – Wesley Chapel
Highland MRI (Lakeland)
Winter Haven MRI
Brandon MRI
Sarasota MRI
Brandenton MRI
Venice MRI
Venice MRI-Port Charlotte

MODALITIES

High Field MRI
Wide Bore HF MRI
High Field Open MRI
Arthrograms
MRA | MRV
MRCP
Diffusion Tensor (DTI)

Susceptibility Weighted (SWI)
NeuroQuant
CT Scan | CTA
Echocardiograms
Ultrasounds
X-Rays
DEXA – Bone Density
3D Mammography
Health Screenings

QUICK LINKS

Schedule Appointment
Physician Access
Patient Access
Attorney Access
Insurances Accepted
Exam Preparation
Pay Your Bill
Contact Us

Staff Resources