If you ticked yes, please state the preferred date and time you would need the report by:
MRI: Please complete the following safety questions
Does the patient have a Cardiac pacemaker, cochlear implants, cerebral aneurysm clips?*
Has the patient had surgery in the last 8 weeks?*
Does the patient have a history of metallic foreign body to the eye?*
Is there a possibility of pregnancy/breast feeding?*
Does the patient have or has had renal impairment? If so we need eGFR score before giving contrast.*
Provide eGFR score
Does the patient have a history of allergies?*
Does the patient have any implants or other foreign bodies in your body e.g. replacement joints, plates, drug pumps, wires, clips or shrapnel?*
CT: Please complete the following safety questions
Is there a possibility of pregnancy/breast feeding?*
Does the patient have or has had renal impairment?* If so we need eGFR score before giving contrast.
Provide eGFR score
Does the patient have a history of allergies?*
Any history of diabetes?*
Is the patient on metformin or glucophage?*
For all patients requiring I.V. Contrast
Has the patient had a contrast injection before? *
Is the patient likely to have a raised serum creatinine?*
