MRI Scheduling Form

Did you know that CMI can do the scheduling for you? Just complete and fax the attached form and we will contact the patient!

When scheduling an MRI, you have two options:

 1.     Use the attached form and fax to our scheduling center at 315-792-9698. If the provider signs the bottom, this form can be used as a script or you can fax a script with this form. CMI will call the patient and set the appointment up for you. It is important that the patient’s demographic, insurance, order and referring provider information and contrast protocol screening if pertinent is complete and accurate.

2.     You can contact by phone and speak to our Scheduling Specialists at 315-792-1985 and schedule directly.

3.     With Stats appointments please call!

Please note, that some referring offices, prefer that the patient hand carry their MRI script and set up their own appointment. We can accommodate this as long as the referring office obtains insurance preauthorization for the study.

Referring providers can also obtain a pad of fax referral forms as well as CMI patient information pamphlets (View our patient brochure here) by contacting our Patient and Providers Relations Department at CMI at 792-4666 or by using the “request materials” email link on this page.


Download our Fax Referral Form