MRI Screening Form (Bartlett Only)

An MRI examination involves the use of a very strong magnet. For your safety, the presence of certain metallic objects must be determined before entering the exam room. If you answer yes to any implanted devices, please provide implant card and inform the MRI Technologist.

The following items may be harmful to you during your MRI scan and may interfere with the MRI exam. Please select YES or NO answer to every item listed.