Please select from the following, print out, complete and either FAX to our office at (352)684-0212. or bring with on your visit. Completing this paperwork is not necessary before your appointment, but will save time once you arrive. Depending on the type of exam there could be additional forms to be completed on arrival. Please arrive 15 minutes prior to appointment time.

Patient safety is priority one at Crystal River MRI. Please follow these instructions thoroughly as this could cause rescheduling of your appointment.

MRI Abdomen / MRCP / MRA Abdomen:

• FAST 4-6 Hours prior to exam

Your Trust in our Knowledge and Expertise is very important to us. Our patients are our number one priority and your confidence in Crystal River MRI is our greatest success. We will always strive to provide Quality Patient Care and work hard to earn your business.

Please take a moment and let us know about your experience at Crystal River MRI.

If you would like us to contact, you regarding your visit please complete the contact information below.

Please complete the following information to obtain your medical records from Crystal River MRI. A member of our team will contact you in the next 72 hours to complete request.

Images:
X-Ray Film: $25.00 Per Exam
MRI/CT Film: $80.00 Per Exam
MRI/CT Film (With/Without Contrast): $160.00 Per Exam
Exam CD: $25.00 Per CD

Records:
Up To 25 Pages: $1.00 Per Page
Each Additional Page: $0.25 Per Page

Patients are given one courtesy CD of their examination. If a second CD of your exam is required there is a $25.00 duplication fee. This fee needs to be paid before records will be released. Payment must be received prior to records being released.

Please use the button below to make a payment. Note: when you click it will open in a new tab.