Patient Forms

To make your check-in process easier and faster, you can download the forms below. Simply fill them out and bring them with you to your appointment, or fax to (626) 821-3460.

Patient Information Form

Patients, please download and fill out this form prior to coming in for your appointment.

English Spanish Mandarin

MRI Information Form

MRI patients, please download and fill out this form prior to coming in for your appointment.

English Spanish Mandarin

Patient Questionnaire

As required by the HITECH Act, patients visiting Arcadia Radiology Medical Group will need to fill out the Patient Questionnaire each time they arrive for an appointment.

English Spanish Mandarin

Authorization For Use Or Disclosure
Of Protected Health Information

Patients, please use this form when you wish to have your protected health information released to you or another party. You may bring this form to our office or fax it to (626) 821-3460.

English