For your convenience, DRI has a dedicated page for many medical forms and educational materials relating to your imaging procedure. Before your appointment at DRI, you may wish to download, print, and complete medical forms and review educational materials. Completing medical forms may save time when you arrive. Be sure to bring the completed forms with you to your appointment. If you have any questions, please contact DRI at (336) 433-5000.
All Patients
Medical Release Form
Notice of Privacy Practices
Receipt of Privacy Practices Notice
Financial Aid Form
Bone Density (DXA) Patients
CT Scan Patients
Interventional Radiology Patients
Mammogram Patients
MRI Patients
MRI Brain History
MRI Upper Extremity History
MRI Lower Extremity History
MRI Spine History
Breast MRI History
Chest, Abdomen and Pelvis MRI History
Spine Procedures
Informed Consent
Policy Regarding Drivers
Spinal Post-Procedure Instructions
Spine Information Booklet
Stereotactic Breast Biopsy Patients
Vein Treatment Patients
Patient Venous History
Informed Consent
Endovascular Consent
Pre-Procedure-Instructions (Venacure)
Post Laser Vein Treatment Instructions
Varicose Vein Therapy FAQs
Virtual Colonoscopy Patients
Virtual Colonoscopy Request
Virtual Colonoscopy Waiver of Liability
Virtual Colonoscopy Patient Prep Form