• SG Radiology and Associates Ltd
    Community AQP - MRI Direct Access Referral

    NB. Suspected cancer patients must be referred via the 2 week wait process

  • SECTION 1: PATIENT DEMOGRAPHIC DETAILS

  • SECTION 2: SELF REFERRAL

  • SECTION 3: CLINICAL DETAILS / SYMPTOMS

  • Clinical Condition / Symptoms and Clinical Indication

    (including relevant previous medical and drug history, please include patient BMI)

    Patients must be clinically examined before requesting MRI
  • Exclusion Criteria
  • Age under 18
    Weight over 170kg
    Hospital inpatients
    Knee red flags
    Metallic IOFG^ - confirmed by x-ray
    Non-NHS patients
    Patients requiring general anaesthetic
    Patient in first trimester of pregnancy
    Suspected cancer
    Suspected TIA
  • MRI Contraindications
  • ^ If Metallic IOFB (Intra-Ocular Foreign Body), a report from orbit x-ray is required with the referral.
    ** If Heart Valve Prosthesis - make, model & serial number may be requested to determine MRI compatibility.
  • Examination Request
  • (please specify body part(s) to be imaged)
  • Clinical question to be answered by the scan
  • Previous Imaging
  • When and Where undertaken? Copy of report is required with the referral
  • Do any of the following apply to your patient?

CONTACT US

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PHONE

03333 445160

EMAIL

enquiries@sgrl.co.uk