Forms
The following forms are provided for health care providers to order imaging exams at all of the Vantage Radiology sites. Please print the form of your choice and either fax it to the facility directly or have the patient present it at the site at time of the appointment.
You will need Adobe’s FREE Acrobat Reader to view the following files.
Auburn Diagnostic Imaging Services
- ADIS Map & Driving Directions (730K PDF)
- ADIS Fax Scheduling Referral (261K PDF)
- MRI Contrast Consent Form (24K PDF)
- Musculoskeletal/Spinal Injections Form (316K PDF)
MultiCare – Auburn Medical Center
Overlake Breast Health Center
The Breast Center
UW Medicine – Valley Medical Center
- UW Medicine – Valley Medical Center (990K PDF)
- Interventional Order Form (1.1MB PDF)
- Nuclear Medicine Order Form (990K PDF)
- IR Clinic – Registration Form (264K PDF)
Valley Diagnostic Imaging Services – Medical Arts Center
Valley Diagnostic Imaging Services – Olympic Building
- PET Referral Forms
- Breast MRI Order Form (627K PDF)
- MRI/CT Referral Form (990K PDF)
- MRI Contrast Consent Form (24K PDF)
- CT Lung Screen Supplemental Form
- Podiatry/Musculoskeletal Form (513K PDF)