ultrasound, CT scan, PET scan, CT angiography, PET/CT, Riverside, Corona, Ontario, Eastvale, Norco

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phone: 951 284 1920 | fax: 951 284 1921

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    Medical Records Request Form

     

    New Patient Paperwork 

     

    CT Scan Preparation and Medical History

    • Oral and IV contrast

    • Oral and IV Contrast (Diabetic)

    • IV Contrast 

    • IV Contrast (Diabetic)

    • Without Contrast

    • CT Medical History Form

     

     

    PET Scan Preparation and Medical History 

    • Patient Preparation (10am/11am)

    • Patient Preparation (Diabetic- 10am/11am)

    • Patient Preparation (12pm/1pm)

    • Patient Preparation (Diabetic- 12pm/1pm)

    • PET Medical History Form


     

    Ultrasound Patient Preparation

    • Abdominal Patient Preparation

    • Kidney & Bladder Patient Preparation

    • Bladder Only Patient Preparation

    • Kidney Only Patient Preparation

    • Pelvis/ Obstetrics Patient Preparation

    • Lower/ Upper Extremities (Vascular) Patient Preparation

    • Scrotum/ Breasts/ Soft Tissue Patient Preparation

    • Transvaginal Ultrasound Consent Form

    • Abdominal/ Renal Patient Questionnaire

    • Breast Patient Questionnaire 

    • Pelvic Patient Questionnaire 

    • Thyroid Patient Questionnaire

    • Venous Doppler Patient Questionnaire

    • Testicular Patient Questionnaire

    • Scrotal Patient Questionnaire

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    Inland Empire Imaging Center

    260 East Ontario Ave, Suite 101A, Corona, CA 92879

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