Get the free MRI Head Questionnaire

This document is a questionnaire used to assess patients prior to undergoing an MRI scan of the head, collecting information on symptoms, medical history, and previous imaging studies.

How to fill out mri head questionnaire

How to fill out MRI Head Questionnaire

1. Start by entering the patient's personal information, including their name, date of birth, and contact details.
2. Review the patient's medical history, including any neurological conditions or previous surgeries.
3. Ask the patient to list any medications they are currently taking, including dosages.
4. Include questions about any allergies to contrast agents or other substances.
5. Inquire about any current symptoms the patient is experiencing, such as headaches, vision changes, or seizures.
6. Review any relevant family history of neurological disorders.
7. Ensure that the patient understands the purpose of the MRI and the questionnaire.
8. Have the patient sign and date the questionnaire where indicated.

Who needs MRI Head Questionnaire?

1. Patients with neurological symptoms such as headaches, seizures, or cognitive changes.
2. Individuals with a history of brain injuries or neurological conditions.
3. Patients referred for an MRI by healthcare providers for diagnostic purposes.
4. Anyone who may require monitoring for conditions such as tumors, strokes, or other brain disorders.

People Also Ask about

Is there anything you shouldn't do before an MRI?

Don't apply personal care products. Personal care items like make-up, antiperspirants, powders and lotions may include elements that can interfere with the clarity of your imaging. So, feel free to shower as normal, just don't apply personal products until after your appointment.

What are four common questions you would ask a patient on an MRI safety questionnaire?

MRI Safety Screening Form Explained Is MRI safe? Date of birth, Sex, Weight, Height. Do you have a heart pacemaker or pacing wires? Have you had any heart surgery (e.g. coronary stent, heart valve replacement, PFO closure)? Have you had any surgery to your head including eyes / ears / brain?

What is an MRI safety questionnaire?

The MRI Safety Screening Form asks personal questions about you and your health. Click on the questions below to find out why we ask them. The radiographers are very happy to answer any questions about your MR scan.

What questions are asked before an MRI scan?

8 Has the patient ever had any metal enter their body e.g. intraorbital metal, or worked as a welder? 9 Does the patient have any artificial joints, screws, pins or plates for fractures? 10 Does the patient have any implants?

What disqualifies you from getting an MRI?

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

What is the difference between a head MRI and a brain MRI?

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

What questions do they ask you before an MRI?

If you are receiving a Brain MRI, please answer the following questions: Do you have a brain tumor? Do you have seizures? If so, what type? Have you had brain surgery?

For pdfFiller’s FAQs

What is MRI Head Questionnaire?

The MRI Head Questionnaire is a form used to collect relevant medical history and information about a patient prior to undergoing an MRI scan of the head.

Who is required to file MRI Head Questionnaire?

Patients scheduled for an MRI of the head are required to file the MRI Head Questionnaire to ensure their safety and provide essential information to the medical staff.

How to fill out MRI Head Questionnaire?

To fill out the MRI Head Questionnaire, patients should carefully read each question and provide accurate information about their medical history, any current medications, allergies, and previous surgeries or conditions related to the head.

What is the purpose of MRI Head Questionnaire?

The purpose of the MRI Head Questionnaire is to assess any potential risks or contraindications before the MRI procedure and to gather vital information that helps in evaluating the patient's condition.

What information must be reported on MRI Head Questionnaire?

Patients must report their medical history, current medications, allergies, history of surgeries, recent illnesses, and any implants or devices in their body that could affect the MRI examination.