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Austin Radiological Association PET/CT PRESCHEDULING FORM ARA SCHEDULING 512.458.9098 fax 512.836.8869 PATIENT INFORMATIONREFERRING Informational:Referring physician signature:Date of birth:Date:Phone:

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How to fill out petct pre-scheduling form

01

Start by entering your personal information such as name, address, and contact details.

02

Provide your medical history, including any relevant previous diagnoses, treatments, or surgeries.

03

Specify the reason for your PET-CT scan, whether it is for cancer staging, monitoring treatment response, or other medical purposes.

04

Indicate any known allergies or sensitivities to medications.

05

If you are currently taking any medications, list them along with the dosages.

06

Mention any specific dietary restrictions or fasting requirements for the scan.

07

Provide information about your primary physician or referring doctor.

08

Specify the desired date and time for your PET-CT appointment, if applicable.

09

Include any additional instructions or concerns that you may have.

10

Once you have filled out all the necessary information, review it for accuracy and submit the form.

Who needs petct pre-scheduling form?

01

Anyone who requires a PET-CT scan needs to fill out the pre-scheduling form. This includes individuals with suspected or diagnosed cancer, those undergoing cancer treatment, individuals monitoring treatment response, and patients with certain other medical conditions where PET-CT scans are necessary for accurate diagnosis or assessment.

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What is petct pre-scheduling form?

The PETCT pre-scheduling form is a form used to request an appointment for a PET/CT scan procedure.

Who is required to file petct pre-scheduling form?

Patients who have been recommended to undergo a PET/CT scan procedure are required to file the PETCT pre-scheduling form.

How to fill out petct pre-scheduling form?

The PETCT pre-scheduling form can be filled out online on the healthcare provider's website or by contacting the scheduling department directly.

What is the purpose of petct pre-scheduling form?

The purpose of the PETCT pre-scheduling form is to secure an appointment for a PET/CT scan procedure and provide necessary information to the healthcare provider.

What information must be reported on petct pre-scheduling form?

Information such as personal details, medical history, insurance information, referring physician details, and preferred appointment dates may need to be reported on the PETCT pre-scheduling form.

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