Download Medical Imaging Forms

Film Report Request Form
FILM/REPORT REQUEST FORM
Patients, please download and fill out this form to obtain copies of your films or imaging reports. You can simply sign, scan and email your records request to imirecords@imirad.com.
If you prefer to mail or fax the form, Contact the Intermountain Medical Imaging records department at 208.954.8130.
barium-enema-small-bowel-follow-through-IVP-prep
BARIUM ENEMA ADULT PATIENT PREP
Patients, please download these preparation instructions when your physician has ordered a Barium Enema, Small Bowel Follow-Through or an IVP exam.
IVP-SBFT-prep
IVP, SMALL BOWEL FOLLOW-THROUGH PREP
Patients, please download these preparation instructions when your physician has ordered an IVP, Small Bowel Follow-Through exam.
Arthrography Patient Education
Arthrography Patient Education Arthrography helps physicians evaluate alterations in structure and function of a joint and help to determine the possible need for treatment, including arthroscopy, open surgery or joint replacement.
Dotarem Medication Guide
Dotarem Medication Guide
Learn about the medication Dotarem given intravenously during MRI exams. This educational document explains what Dotarem is and important information you should know. Click here for a Spanish version of this medication guide.
Lumbar Selective Nerve Root Block
Lumbar Selective Nerve Root Block
For Low Back & Leg Pain
A lumbar selective nerve root block is a target-specific epidural steroid injection for diagnosing and treating low back and leg pain.
Lumbar Transforaminal Epidural steroid Injection
Lumbar Transforaminal Epidural Steroid Injection
For Low Back & Leg Pain
A lumbar tranforaminal epidural steroid injection is an outpatient procedure for treating low back and leg pain.
Myelogram Patient Education
Myelogram Patient Education
A myelogram is a simple test performed to look at the spinal sac and the nerve roots that exit from the spinal canal.
Sacroiliac Joint Injection
Sacroiliac Joint Injection
For Chronic Low Back & Buttock Pain
A sacroiliac joint injection is an outpatient procedure for treating low back and buttock pain.
Lumbar Facet Injection
Lumbar Facet Injection
For Chronic Low Back Pain
A lumbar facet injection is an outpatient procedure for diagnosing and treating low back, button, hip and groin pain.
Lumbar Medial Branch
Lumbar Medial Branch Block
For Chronic Low Back Pain
A lumbar medial branch block is an outpatient procedure for diagnosing and treating low back, buttock, hip, and groin pain.

Request a Price Quote