Patient Forms

To expedite your appointment wait time, please print and fill out these patient forms and bring with you at the time of your appointment.

Medical Record Request – Release Form

• Complete form with signature.
• For the most prompt results, fax the completed form to facility where imaging was performed.
• Bring form with any images you obtained to Radiology Regional appointment.

   

• You may also release Radiology Regional images with this form.

Other Documents