Enter your biological sex *
Which best describes your primary reason for your whole body MRI? *
Do you have any allergies? *
Were you operated for the heart for a cardiac valve or cardiac battery? *
Did you undergo an operation of the brain? *
Did you ever get metal shards, even long ago, in particular near eyes? *
Have you ever had a biopsy? *
Are you claustrophobic or do you suspect you might be claustrophobic? *
Will you take an oral sedative for your scan? *
Have you ever had spinal surgery where you may have received an implant? *
Do you have any orthopedic prosthetics? *
Are you pregnant or possibly pregnant?
PLEASE TELL US ABOUT YOUR HABITS
Have you ever smoked cigarettes? *
Family & Personal history *
A note about family and personal history:
Although family genes are something you cannot change, attempting prevention or an early control
along with changing unhealthy habits can help you avoid a whole lot of unwanted complications or
problems. Everyone’s family or personal history of disease is different; but knowing about it could
help us analyze and understand the outcomes of the MRI scan better.
Do you or any close member of your family suffer from a neurological pathology? *
Have you or any close member of your family been diagnosed with cancer? *
Have you or any close member of your family been diagnosed with a respiratory condition?(e.g. Asthma, Pneumonia, Tuberculosis etc…) *
Have you or any close member of your family been diagnosed with a cardiovascular condition?(e.g. Arrythmia, Heart attack, Abdominal Aortic Aneurysm) *
Have you or any close member of your family been diagnosed with a abdominal condition?(e.g. Hepatitis, Kidney infection, Celiac disease, Pancreatitis etc…)
*
How did you hear about Revoscan: *