New Patient Forms

Health Imaging Services
Non-invasive Diagnostic Imaging in Cullman, AL

New Patient Forms

(Patient has never had a scan at Health Imaging Services must complete the following forms)
Click on each to download, print, and fill out.

Consent Form

Notice of privacy practices acknowledgement

patient authorization to release patients information

PET cT prep instructions

PET CT Prep instructions back side of form (Map)

Financial statement

Notice of privacy practices

Patient Registration form

Worksheet