Complete Your Patient Forms

Which forms should I complete?

• •All patients: Patient Intake Form
• •MRI patients: Patient Intake Form plus MRI Safety Screening Form
• •CT patients: Patient Intake Form plus the CT Screening Form if instructed by GHI
• •Ultrasound, echocardiogram, or X-ray patients: Patient Intake Form unless GHI gives you additional instructions
• •Returning patients: complete updated forms if your information has changed or if GHI asks you to do so

If you are scheduled for more than one type of exam, complete the forms for each applicable exam. When in doubt, call our team before submitting a form.

English Forms

• Patient Intake Form — complete this form for your first visit or when GHI asks you to update your patient information.
• MRI Safety Screening Form — complete this form if you are scheduled for an MRI. It helps the imaging team identify implants, devices, metal exposure, surgical history, and other MRI safety considerations.
• CT Screening Form — complete this form if GHI instructs you to do so for your CT appointment. The form helps the team review relevant safety and exam information.

Formularios para pacientes en español

Si necesita ayuda para completar los formularios, llámenos al (678) 924-0964.

These forms open in a secure external browser window through Doctible. After submitting a form, return to this page or call GHI at (678) 924-0964 if you need additional assistance. These forms are hosted through our secure online form system.

Before you begin

• •Have your photo ID available.
• •Have your insurance information available if you are using insurance.
• •Know the name of the exam you are scheduled to receive.
• •Have a list of relevant medications and medical devices available when completing the forms.
• •Complete the forms before arriving whenever possible.
• •If you do not have access to the internet or need help, call GHI at (678) 924-0964.