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Click ‘Get Form’ to open the MRI checklist in the editor.
Begin by affixing the patient label at the top of the form. This helps in identifying the patient easily.
Fill in your name, weight, and height in the designated fields to provide essential personal information.
Indicate the reason for the MRI and describe any symptoms you are experiencing. If there was an injury, mark 'Y' or 'N' and provide further explanation if applicable.
In the section regarding medical history, check 'Yes' or 'No' for each item listed. This includes any implants, previous surgeries, or conditions that may affect your MRI.
For female patients, complete the questions about menstrual history and pregnancy status as required.
Finally, sign and date the form at the bottom to attest that all information is accurate. Specify who completed the form.

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What should you avoid before an MRI?

Before the Examination Jewelry including rings, earrings, necklaces, or watches. Pens, pocketknives, and eyeglasses. Credit cards and other cards containing magnetic data. Pins, hairpins, and similar metallic items, which can distort MRI images. Clothing has metal hooks, buttons, zippers, or other metal items on it.

What is not allowed in MRI?

As a patient, it is vital that you remove all metallic belongings in advance of an MRI examination, including external hearing aids, watches, jewelry, cell phones, and items of clothing that have metallic threads or fasteners.

What disqualifies you from getting an MRI?

you think you have any metal in or on your body. youre pregnant or breastfeeding. youve ever had an allergic reaction to a contrast agent. you have kidney problems.

What are the requirements before an MRI?

Remove all metal items such as hair clips, jewelry, watches, hearing aids and dentures. Credit cards will be erased if brought into the MRI. You will be asked to change into a gown for your exam. Tell your doctor and the MRI technologist if you suffer from claustrophobia (fear of being closed in).

What interferes with MRI results?

You will typically be asked to change into a gown and to remove things that might affect the magnetic imaging, such as: Jewelry. Hairpins. Eyeglasses. Watches. Wigs. Dentures. Hearing aids. Underwire bras.

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How to use or fill out MRI Checklist with our platform

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Complete this form in 5 minutes or less

Got questions?

What should you avoid before an MRI?

What is not allowed in MRI?

What disqualifies you from getting an MRI?

What are the requirements before an MRI?

What interferes with MRI results?

Security and compliance

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Mri checklist 2026

Here's how it works

How to use or fill out MRI Checklist with our platform

See more mri checklist versions

Complete this form in 5 minutes or less

Got questions?

What should you avoid before an MRI?

What is not allowed in MRI?

What disqualifies you from getting an MRI?

What are the requirements before an MRI?

What interferes with MRI results?

mri checklist form

Security and compliance

mri safety checklist

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