If you have an appointment at Mesquite Diagnostics, you may print out the Patient Data Form below and complete it in advance of your arrival. If you have any questions, please ask the receptionist at the center or call directly at 972-686-1944. You will need to have Adobe Reader on your computer to open the documents on this page.
Click here to download the Patient Data Form.
Your physician may have ordered a study with a contrast injection. If so, you will need to complete this Contrast Material Consent Form which asks about allergies and medications currently being taken. You may print out this form and bring it with you.
Click here to download the Contrast Material Consent Form.
All females of child-bearing age (10-55 years of age) will be asked to complete a Pregnancy Questionnaire Form as a precaution to avoid the exposure of an early pregnancy to harmful radiation. You may print out this form and bring it with you.
Click here to download the Pregnancy Questionnaire Form.
Physician office: Click here to download an Order Form.