• Magnetic Resonance Imaging (MRI) Safety Questionnaire

  • Please answer Yes or No

    If you have answered yes to any of the below safety questions, please contact the MRI Lido De France MRI scanning unit ASAP, otherwise when you arrive for your scan, we may be unable to proceed with the appointment and have to cancel your MRI examination.
  • 1. Have you ever had an operation or procedure on your heart?*
  • 2. Do you have a pacemaker, stents, pacing wires or heart valve replacement?*
  • 3. Do you have any aneurysm clips or programmable shunts?*
  • 4. Have you had an operation on your head, eyes or ears? (NOT CATARACTS, GROMMETS OR LASER TREATMENT)*
  • 5. Do you have any type of electronic, mechanical or magnetic implant? (NOT JOINT REPLACEMENTS)*
  • 6. Have you ever, at any time in your life had any metal particles in your eyes E.g. from welding work?*
  • 7. Have you had any operations within the last six weeks?*
  • 8a). Is there any possibility that you may be pregnant?*
  • 8b). Are you breast-feeding?*

  • If you have answered YES to any of the Questions 1-8, please contact the us on 01534 517332 before your appointment. Failure to do so may result in your appointment being postponed.

  • Do you have any metal plates, pins or clips in your body? (E.g. joint replacements) NOT FILLINGS*
  • Do you have EPILEPSY or DIABETES?*
  • Have you had an MRI scan before?*
  • Are you wearing any patches e.g. HRT or nicotine?*
  • Do you have anything else in you or on you weren't born with*

  • Please inform the radiographer when you come for you scan, if you have any of the following: Dentures containing metal; hearing aid; artificial limb; or calliper; shrapnel injury; tattoos or piercings.

  • We will check your questionnaire when you arrive for your MRI appointment.

    I can confirm that i have been asked the above questions and the information is correct to the best of my knowledge.

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