X-Ray Safety Questionnaire

"*" indicates required fields

08/31/2025
Name*
MM slash DD slash YYYY
MM slash DD slash YYYY

The following items may be harmful to you during your X-Ray scan or may interfere with the X-Ray examination. Please provide a “yes” or “no” answer.
Safety Question ( for women only): Any chance you are pregnant?

Instruction for the Patient, Parent or Guardian:

Remove jewelry or body piercings in the area of examination.
MRI Associates Attorney Portal
Effective immediately, all of our facilities are using the Clearpath platform to fulfill and process all legal requests. These requests include client records, reductions, all subpoenas, images and reports.

Please setup a login with Clearpath here:

Why are we using Clearpath?

  • All requests for records, images, and billing must be done securely & digitally through the platform
  • Receive records including images digitally
  • Eliminate all mail, drop offs, pickups, paperwork, slow check payments
  • Reduced processing time