Patient Forms The following forms are available for download as PDFs: Patient History Authorization To Obtain Medical Records Notice of Privacy Practices & Acknowledgement of Receipt Acknowledgement of Financial Responsibility Assignment of Benefits Advanced Beneficiary Notice Non Covered Service Per Insurance Disclosure and Consent - Intravenous Contrast Injection Patient Preparation and Driving Directions for CT Scans Patient Preparation and Driving Directions for MRI Patient Preparation and Driving Directions for PET/Cardiac PET Perfusion Scans Patient Preparation and Driving Directions for Nuclear Stress Test Patient Preparation and Driving Directions for Stress Echocardiogram   Westside Medical Imaging is the Diagnostic Division of Westside Medical Associates of Los Angeles

Home | About Us | Scanning Services | Our Doctors | Patient Info | Referring Physicians | Media Center | Contact Us

Westside Medical Associates of Los Angeles

Copyright ©2013 Westside Medical Imaging
64-Slice CT Scan, Body, Heart, and Vascular Imaging in Southern California
99 N La Cienega Blvd. • Suite 103 • Beverly Hills, CA • 310.623.1150