---
title: Medical Imaging Center Lost Belongings Report Form Template | Paperform
description: Professional form template for reporting lost items at radiology and imaging centers. Includes appointment details, scan type, changing room location, and item description for efficient recovery.
url: "https://paperform.co/templates/medical-imaging-center-lost-belongings-report"
type: static
generatedAt: "2026-03-28T00:44:28.634Z"
---

[← Back to free form templates](/templates/)    ![Medical Imaging Center Lost Belongings Report](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/medical-imaging-center-lost-belongings-report.png)
    [Preview](https://_preview.paperform.co/ai-template/medical-imaging-center-lost-belongings-report) [Use this template for free](/create?ai-template=medical-imaging-center-lost-belongings-report)    [Lost & Found Forms](/templates/category/lost-found/)[Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/) [Technician](/templates/role/technician/)[Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
Losing personal belongings during a medical appointment can be stressful, especially when you're already focused on your health. This **Medical Imaging Center Lost Belongings Form** streamlines the process of reporting and recovering lost items at radiology departments, imaging centers, and diagnostic facilities.

Whether it's jewelry removed before an MRI, a phone left in a changing room, or a jacket forgotten after a CT scan, this form captures all the essential details staff need to locate your belongings quickly. The form collects appointment information, scan type, changing room or area used, detailed item descriptions, and technician names to help narrow down the search.

### Perfect for radiology departments and imaging centers

Medical imaging facilities handle dozens of patients daily, each using changing rooms and waiting areas where personal items can easily be misplaced. This template helps healthcare administrators, front desk staff, and imaging technicians maintain an organized lost and found system that respects patient privacy while efficiently reuniting people with their belongings.

### How Paperform makes recovery easier

Built on [Paperform](https://paperform.co), this template lets you customize fields for your specific facility layout, add conditional logic to show relevant questions based on scan type, and automatically notify the right staff members via email. You can embed the form on your patient portal, link it from appointment confirmation emails, or display it in your waiting room via QR code.

Use [Stepper](https://stepper.io) workflows to automatically log lost items into a tracking spreadsheet, send follow-up notifications to patients when items are found, or create tasks for staff to check specific areas. For facilities managing multiple locations, you can route reports to the appropriate site administrator automatically.

This form helps medical imaging centers provide compassionate, organized patient care that extends beyond the scan itself—because recovering a lost wedding ring or wallet can make all the difference in a patient's experience.
       Built for growing businesses, trusted by bigger ones.   Trusted by 500K+ business owners and creators, and hundreds of millions of respondents.     ![Capterra - 4.8 out of 5](/images/capterra-st.jpg)
 ![Trustpilot - 4.8 out of 5](/images/trustpilot-st.jpg)
 ![G2 - 4.8 out of 5](/images/g2-st.jpg)
  [Try Paperform free now](/register)
## More templates like this
  [![Maternity Ward Lost Belongings Report Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/maternity-ward-lost-belongings-report-form.png)

### Maternity Ward Lost Belongings Report Form

A compassionate form for new parents to report lost or missing personal belongings during their maternity ward stay, helping hospital staff locate and return items quickly.](/templates/maternity-ward-lost-belongings-report-form/)
[![Rehabilitation Hospital Lost Belongings Report](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/rehabilitation-hospital-lost-belongings-report.png)

### Rehabilitation Hospital Lost Belongings Report

A professional form for patients, families, and staff to report lost or missing items in rehabilitation hospital settings with automatic case manager notification.](/templates/rehabilitation-hospital-lost-belongings-report/)
[![Sleep Study Center Lost Item Report](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/sleep-study-center-lost-item-report.png)

### Sleep Study Center Lost Item Report

Report lost or missing items from your sleep study visit. Submit details about your lost belongings so our team can locate and return them to you promptly.](/templates/sleep-study-center-lost-item-report/)
[![Cardiac Catheterization Lab Lost Belongings Report](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/cardiac-catheterization-lab-lost-belongings-report.png)

### Cardiac Catheterization Lab Lost Belongings Report

Report lost or misplaced personal belongings during your cardiac catheterization procedure. Help us locate your items by providing detailed information about when and where they may have been left.](/templates/cardiac-catheterization-lab-lost-belongings-report/)
[![Children's Hospital Lost Item Report](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/childrens-hospital-lost-item-report.png)

### Children's Hospital Lost Item Report

A comprehensive lost item report form designed for children's hospitals to help families locate missing belongings from patient rooms, play areas, and family lounges with automated specialist notification.](/templates/childrens-hospital-lost-item-report/)
[![CPAP Mask Fitting Questionnaire](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/cpap-mask-fitting-questionnaire.png)

### CPAP Mask Fitting Questionnaire

A comprehensive CPAP mask fitting questionnaire that collects facial measurements, sleep preferences, pressure settings, and comfort assessments to help find the perfect mask fit.](/templates/cpap-mask-fitting-questionnaire/)
[![Employee Health Clinic Lost Property Report](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/employee-health-clinic-lost-property-report.png)

### Employee Health Clinic Lost Property Report

Report lost items at your workplace health clinic with appointment details, location, and item description to help our occupational health team reunite you with your belongings.](/templates/employee-health-clinic-lost-property-report/)
[![Hospice Care Facility Lost Belongings Report](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/hospice-care-facility-lost-belongings-report.png)

### Hospice Care Facility Lost Belongings Report

A compassionate form for reporting lost or missing personal belongings in hospice care facilities, helping staff track items and notify families promptly.](/templates/hospice-care-facility-lost-belongings-report/)
[![Interventional Radiology Procedure Intake Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/interventional-radiology-procedure-intake-form.png)

### Interventional Radiology Procedure Intake Form

A comprehensive intake form for interventional radiology procedures including patient history, imaging review, anticoagulation status, contrast allergy screening, and procedural consent documentation.](/templates/interventional-radiology-procedure-intake-form/)
[![Missing Postpartum Mother Report with Welfare Concerns](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/missing-postpartum-mother-report-with-welfare-concerns.png)

### Missing Postpartum Mother Report with Welfare Concerns

A sensitive, comprehensive form for healthcare providers and social services to report missing postpartum mothers enrolled in maternal mental health programs, including depression screening data and infant welfare concerns.](/templates/missing-postpartum-mother-report-with-welfare-concerns/)
[![Mobile Phlebotomy Appointment Checklist](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/mobile-phlebotomy-appointment-checklist.png)

### Mobile Phlebotomy Appointment Checklist

A comprehensive checklist for mobile phlebotomists to ensure proper patient identification, requisition verification, sample collection, and transport preparation before, during, and after each appointment.](/templates/mobile-phlebotomy-appointment-checklist/)
[![Nursing Home Lost Belongings Report Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/nursing-home-lost-belongings-report-form.png)

### Nursing Home Lost Belongings Report Form

A compassionate form for reporting lost or missing personal items belonging to nursing home residents, helping staff quickly locate belongings and notify family members.](/templates/nursing-home-lost-belongings-report-form/)