---
title: MRI Imaging Consent Form with Metal Screening & Safety Assessment | Paperform
description: Complete MRI consent form template with metal implant screening, claustrophobia assessment, contrast authorization, and HIPAA compliance for radiology departments and imaging centers.
url: "https://paperform.co/templates/mri-imaging-consent-safety-screening-form"
type: static
generatedAt: "2026-03-28T00:44:34.716Z"
---

[← Back to free form templates](/templates/)    ![MRI Imaging Consent & Safety Screening Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/mri-imaging-consent-safety-screening-form.png)
    [Preview](https://_preview.paperform.co/ai-template/mri-imaging-consent-safety-screening-form) [Use this template for free](/create?ai-template=mri-imaging-consent-safety-screening-form)    [Healthcare & Medical Forms](/templates/category/healthcare/)[Legal & Compliance Forms](/templates/category/legal/) [Healthcare](/templates/industry/healthcare/)[Telehealth](/templates/industry/telehealth/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)[Radiologist](/templates/role/radiologist/)     About this free form template
### Streamline MRI Consent and Safety Screening with Paperform

Magnetic Resonance Imaging (MRI) requires thorough patient preparation, safety screening, and informed consent before any scan can proceed. This **MRI Imaging Consent & Safety Screening Form** template provides healthcare facilities, diagnostic imaging centers, and radiology departments with a comprehensive digital solution that replaces paper-based consent forms with a secure, efficient online workflow.

#### Why Digital MRI Consent Forms Matter

Traditional paper MRI consent forms create bottlenecks in patient flow, increase administrative burden, and risk incomplete safety screenings. Patients often arrive unprepared, leading to last-minute discoveries of contraindications that delay or cancel procedures. Digital forms allow patients to complete detailed screening questionnaires before their appointment, giving radiologists and technologists time to review responses, identify potential issues, and contact patients if clarification is needed.

Paperform's MRI consent template captures everything required for safe imaging: comprehensive metal implant screening, claustrophobia assessment, contrast media authorization, pregnancy screening, and all necessary HIPAA authorizations. Conditional logic ensures patients only see relevant follow-up questions based on their responses, creating a streamlined experience that's thorough without feeling overwhelming.

#### Built for Healthcare Workflows

This template is designed specifically for **radiologists, imaging center managers, hospital radiology departments, and outpatient diagnostic facilities**. It addresses the unique compliance, safety, and documentation requirements of MRI procedures while maintaining a patient-friendly experience.

Key features include:

 - **Comprehensive metal screening:** Detailed questions about implanted devices, surgical hardware, foreign bodies, and metallic objects that could pose safety risks in the magnetic field
 - **Claustrophobia and anxiety assessment:** Identifies patients who may require sedation, open MRI alternatives, or additional support during the procedure
 - **Contrast media consent:** Separate authorization for gadolinium-based contrast agents with kidney function screening and allergy assessment
 - **HIPAA authorization:** Built-in consent for disclosure of protected health information to radiologists, referring physicians, and insurance providers
 - **Emergency contact collection:** Captures responsible party information for sedation cases or emergency situations
 - **Electronic signature capture:** Legally binding patient and witness signatures with date stamps

#### How Medical Imaging Facilities Use This Template

**Radiology departments** send this form via email 24-48 hours before scheduled MRI appointments, allowing patients to complete screening at home. Submissions trigger automatic notifications to technologists, who review responses for contraindications before the patient arrives. This advance screening reduces same-day cancellations and improves scheduling efficiency.

**Outpatient imaging centers** embed this form directly on their website booking pages, collecting consent and screening information as part of the appointment confirmation process. Integration with scheduling systems ensures all safety information is available in the patient's record before they walk through the door.

**Mobile MRI providers** use this form to collect consent and screening remotely, since patients may be at different facilities or locations. The digital format ensures consistent safety screening regardless of where the scan takes place.

**Hospital systems** integrate this form with their EHR through Stepper workflows, automatically pushing completed consent forms, safety screenings, and authorizations directly into the patient's medical record, eliminating double-entry and ensuring documentation is immediately available to the care team.

#### Automation That Protects Patients and Staff

Safety is paramount in MRI procedures, and this template leverages Paperform's conditional logic to create intelligent screening pathways. If a patient indicates they have a pacemaker, cochlear implant, or other potentially incompatible device, the form immediately displays follow-up questions about device type, manufacturer, and MRI compatibility documentation.

When combined with **Stepper**, Paperform's AI-native workflow builder, this form becomes part of a complete pre-procedure automation:

 1. Patient receives form link via email or text 48 hours before appointment
 1. Completed submission is automatically reviewed for contraindications
 1. If high-risk responses are detected (pregnancy, non-MRI-safe implants, severe claustrophobia), an alert is sent to the radiologist and scheduling team
 1. Approved submissions are pushed to the EHR with all consent and screening documentation
 1. Patient receives automated pre-appointment instructions via email
 1. Technologist has complete safety information available before patient arrival

This automation reduces administrative burden on radiology staff, minimizes safety risks, and creates a better patient experience through proactive communication.

#### Papersign for Complete Documentation

For facilities that require additional consent documents beyond the screening form—such as sedation consent, financial responsibility agreements, or facility-specific policies—**Papersign** provides integrated eSignature capabilities. After completing the MRI screening form, patients can be automatically routed to sign supplementary documents, keeping all consent and authorization materials connected in a single digital workflow.

#### Compliance and Security You Can Trust

Medical imaging facilities handle sensitive health information that requires robust security and compliance measures. Paperform is **SOC 2 Type II compliant and GDPR-ready**, providing enterprise-grade security for patient data. All submissions are encrypted in transit and at rest, and access controls ensure only authorized staff can view patient information.

The form includes all necessary HIPAA authorization language, allowing patients to consent to disclosure of their imaging results to referring physicians, specialist consultants, and insurance providers. This authorization is captured with the same legal validity as paper forms, but with better tracking, easier retrieval, and integration with digital health records.

#### Customization for Your Facility

While this template provides comprehensive MRI-specific screening, it's fully customizable to match your facility's protocols, equipment, and patient population. Add your logo and brand colors, include facility-specific instructions, modify screening questions to match your radiologist's preferences, or add fields for research study consent if you conduct clinical trials.

For **multi-location imaging networks**, Paperform's agency features allow you to maintain a master template while customizing location-specific information, ensuring consistent safety screening across all sites while accommodating local requirements.

#### Better Patient Experience, Better Outcomes

Digital MRI consent forms demonstrate to patients that your facility values their time and prioritizes their safety. Rather than arriving early to complete lengthy paperwork in a waiting room, patients can thoughtfully complete screening questions at home, reference medication lists, check with family members about their medical history, and ask questions before their appointment.

This advance preparation reduces patient anxiety, improves the accuracy of screening information, and allows your team to provide personalized care from the moment the patient arrives. The result is smoother patient flow, fewer procedure delays, and higher patient satisfaction scores.

#### Get Started in Minutes

This template is ready to use immediately—simply customize the facility information, add your logo, and start sending to patients. Whether you're a single-location imaging center or a hospital-based radiology department, this form provides the foundation for safer, more efficient MRI procedures.

Trusted by healthcare providers worldwide, Paperform helps medical imaging facilities move beyond paper forms to create digital-first patient experiences that improve safety, compliance, and operational efficiency.
       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
  [![Methylene Blue Therapy Patient Identity Verification Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/methylene-blue-therapy-patient-identity-verification-form.png)

### Methylene Blue Therapy Patient Identity Verification Form

A comprehensive patient verification and screening form for methylene blue therapy with identity confirmation, contraindications assessment, mitochondrial function testing, and experimental treatment acknowledgment.](/templates/methylene-blue-therapy-patient-identity-verification-form/)
[![Telemedicine Service Agreement](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/telemedicine-service-agreement.png)

### Telemedicine Service Agreement

A comprehensive service agreement for telehealth providers outlining technology requirements, platform access, prescription limitations, emergency protocols, insurance coverage, and visit fees for virtual healthcare consultations.](/templates/telemedicine-service-agreement/)
[![Ambulatory Surgery Center Pre-Operative Intake Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/ambulatory-surgery-center-pre-operative-intake-form.png)

### Ambulatory Surgery Center Pre-Operative Intake Form

Complete pre-operative assessment for ambulatory surgery patients including anesthesia history, NPO compliance verification, medication management, and same-day discharge planning.](/templates/ambulatory-surgery-center-pre-operative-intake-form/)
[![Brazilian Healthcare Patient Intake Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/brazilian-healthcare-patient-intake-form.png)

### Brazilian Healthcare Patient Intake Form

Complete patient intake form for Brazilian private clinics with CPF, SUS card, medical history, and consent documentation.](/templates/brazilian-healthcare-patient-intake-form/)
[![Fertility Preservation Consent Form for Cancer Patients](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/fertility-preservation-consent-form-for-cancer-patients.png)

### Fertility Preservation Consent Form for Cancer Patients

Medical consent form for cancer patients seeking fertility preservation services, including treatment authorization, HIPAA consent, insurance coverage, storage fees, and future use permissions.](/templates/fertility-preservation-consent-form-for-cancer-patients/)
[![Fertility Treatment Consent Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/fertility-treatment-consent-form.png)

### Fertility Treatment Consent Form

A comprehensive consent form for IVF and fertility treatments, covering treatment authorization, embryo storage decisions, success rates, and financial responsibility agreements.](/templates/fertility-treatment-consent-form/)
[![Healthcare Data Breach Notification Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/healthcare-data-breach-notification-form.png)

### Healthcare Data Breach Notification Form

A secure form for healthcare organizations to notify patients of data breaches, detail compromised information, and provide access to credit monitoring and mitigation services.](/templates/healthcare-data-breach-notification-form/)
[![Healthcare Patient Data Sharing Consent Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/healthcare-patient-data-sharing-consent-form.png)

### Healthcare Patient Data Sharing Consent Form

A comprehensive HIPAA-compliant consent form for healthcare providers to obtain patient authorization for sharing electronic health records, telemedicine data, and protected health information with authorized parties.](/templates/healthcare-patient-data-sharing-consent-form/)
[![Hospice Care Admission and Consent Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/hospice-care-admission-and-consent-form.png)

### Hospice Care Admission and Consent Form

A comprehensive hospice care admission form to collect patient information, treatment consent, DNR preferences, pain management options, HIPAA authorization, and end-of-life care decisions with family notification settings.](/templates/hospice-care-admission-and-consent-form/)
[![Hospice Care Insurance Eligibility & Medicare Benefit Election Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/hospice-care-insurance-eligibility-medicare-benefit-election-form.png)

### Hospice Care Insurance Eligibility & Medicare Benefit Election Form

A comprehensive form for evaluating insurance eligibility and electing Medicare hospice benefits, helping patients and families understand coverage options and make informed care decisions.](/templates/hospice-care-insurance-eligibility-medicare-benefit-election-form/)
[![IV Vitamin Therapy Informed Consent Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/iv-vitamin-therapy-informed-consent-form.png)

### IV Vitamin Therapy Informed Consent Form

Professional informed consent form for IV vitamin therapy services. Collect patient information, medical history, ingredient acknowledgment, and signed consent for vitamin infusion treatments.](/templates/iv-vitamin-therapy-informed-consent-form/)
[![Male Fertility Preservation Identity Verification & Consultation Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/male-fertility-preservation-identity-verification-consultation-form.png)

### Male Fertility Preservation Identity Verification & Consultation Form

A comprehensive identity verification and intake form for male fertility preservation services, including medical consultation, screening consent, genetic counseling, and storage facility selection.](/templates/male-fertility-preservation-identity-verification-consultation-form/)