You may download, print and complete these forms before your visit to our office. Please also bring your insurance card(s) and a photo i.d.

All MRI patients:
Registration Sheet
MRI History Sheet
Medical Records Release

All CT patients:
Registration Sheet
CT History Sheet
Medical Records Release

All Nuclear Cardiology patients:
Registration Sheet
Nuclear Cardiology History Sheet
Medical Records Release

All other patients:
Registration Sheet
Medical Records Release

Additional Forms:
Consent to Perform Radiographical Exam on a Minor
Sedation Consent Form

FRC Referral Script

Florida Radiology Consultants, L. L. C.

63 Barkley Circle, Suites 100 & 101, Fort Myers • 6311 South Pointe Blvd., Suite 600, Fort Myers