Step 6 of your MRI booking

Choose your preferred appointment options

Your MRI scan selections have been saved. Please tell us your preferred appointment dates and time windows below. These are preferences only — our team will contact you to confirm the final appointment.

Continue to appointment preferences ↓

What happens next?

Select your slot Choose an available appointment date and time in the calendar below.

Enter your details Confirm your contact information for the booking.

Complete medical questions You’ll be taken to the final questionnaire next.

Nearly there: once your appointment is selected, please continue through the next step so our clinical team has the information needed before your scan.

Select your appointment below ↓

Step 1 of 7

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Appointment Preference

Please tell us your preferred appointment dates and time windows. These are preferences only — our team will contact you to confirm the final appointment.

Patient Information

Please complete your personal and contact information exactly as it appears on your medical records.

Patient Name(Required)

First Last

Email Address(Required)

Mobile Number(Required)

Address(Required)

Address Post Code

Date of Birth(Required)

DD slash MM slash YYYY

Weight (kg)(Required)

Height (cm)(Required)

Patient Information

Please complete your personal and contact information exactly as it appears on your medical records.

Preferred Appointment Date – Option 1(Required)

DD slash MM slash YYYY

Preferred Time for Option 1

Preferred Appointment Date – Option 2

DD slash MM slash YYYY

Preferred Time for Option 2

NHS Number (if available)

GP Practice Name(Required)

Address(Required)

Address Post Code

GP E-mail Address (if available)

GP Contact Telephone Number(Required)

Do you have a referral letter?(Required)

No, I am self-referring

Yes, I have a referral letter to upload

Upload your referral letter (if available)(Required)

Max. file size: 2 GB.

Clinical Information

Please provide the clinical reason for your MRI scan, including symptoms, relevant medical history and any previous imaging.

Reason for self-referral and/or Reason for Examination & Clinical Information (please include any relevant medical history and symptoms)(Required)

Previous imaging, dates and location

Other Relevant Medical Conditions:

Patient Consent(Required)

I understand this MRI request must be clinically reviewed and approved before an appointment can be confirmed.

I consent to relevant clinical information being shared with my GP or referring clinician if required for my care.

Please review and confirm the following declarations before continuing with your MRI booking request.

MRI Safety Screening

Please answer the following MRI safety questions carefully. These checks are required before any MRI scan can be performed safely.

1. An operation to your heart – pacemaker, defibrillator or stents?(Required)

Yes

Q1a: Which applies?(Required)

Pacemaker

Defibrillator / ICD

Cardiac stent

Other

2. An operation to your head or brain – aneurysm clips, coils or shunts?(Required)

Yes

Q2a: Which applies?(Required)

Aneurysm clips

Coils

Shunt

Other

Q2b: Is the shunt programmable?

Yes

3. Operation to your eyes - prosthetics or eyelid wires/springs, retinal clips?(Required)

Yes

4. Operation to your ears – cochlear implant, stapes implant or other hearing implant?(Required)

Yes

5. Any stents, blood filters or aneurysm repair?(Required)

Yes

6. Any surgery in the past 3 months?(Required)

Yes

7. Any metal inside you from a previous operation? e.g. spinal fixation, joint replacement, tissue expander, pins/plates, wires or coils?(Required)

Yes

8. Any kind of prosthesis, e.g. false limb, false eye, calliper, penile implant(Required)

Yes

9. Any electronic devices attached to or inside your body? e.g. glucose monitor, nerve simulator, drug infusion pump(Required)

Yes

Additional MRI Safety Information

Please continue answering the following MRI safety and medical screening questions.

10. A gastric band(Required)

Yes

Q10a: Is it silicone sleeve/band or metal?(Required)

Silicone sleeve/band

Metal

Other

11. Any retained metallic fragments from a previous injury e.g bullets, needles or shrapnel?(Required)

Yes

Q11a: Have they been removed?

Yes

Other

12. Any bowel investigation in the past 2 months, including swallowing a pill cam? Colonoscopy, endoscopy, gastro-intestinal surgery and if so, were clips used?(Required)

Yes

13. Tattoos, body piercings or medicated skin patches?(Required)

Yes

14. Metallic dentures or dental work?(Required)

Yes

15. Any conditions like diabetes, epilepsy or asthma? If so it is well controlled(Required)

Yes

16. Do you have any allergies (food/hayfever/medicine) that require medical intervention?(Required)

Yes

17. Are you or might you be pregnant?(Required)

Yes

18. Any kidney or liver problems - dialysis, renal failure, recent liver transplant?(Required)

Yes

If yes to any of the above questions, please give details:(Required)

Contrast & Final Declaration

Please review the final MRI safety declarations below.

Please tell us how you heard about us(Required)

Google search

Facebook / Instagram

Recommended by a friend or family member

Recommended by a clinician

Returning patient

Leeds Rhinos

Radio

Leaflet

Other

Do you consent to the injection of contrast medium (dye) if necessary?(Required)

Yes

Confirm(Required)

I confirm that the answers provided are accurate to the best of my knowledge, I understand the procedure and I agree to undergo the MRI scan .

Typically, an injection of contrast medium (a gadolinium-based substance that acts like a dye) is required to complete your scan. It helps highlight specific tissues and enables doctors to more accurately diagnose your condition.

While this contrast medium is generally considered very safe, as with any medication, there is a small risk of an allergic reaction, which in extremely rare instances, can be severe. These reactions are uncommon but may include:

Nausea
Headache
Rash / hives
Sneezing
Vomiting
Dry mouth
Palpitations
Feeling cold

The severity of these reactions can vary, but they are typically mild in most cases. If it is determined that a contrast medium is necessary to complete your scan, it is because the benefits of using the contrast far outweigh any potential risks.

It’s important to understand that the contrast is given to help improve the accuracy of your diagnosis. Most patients experience no reaction at all.

If you have any additional questions about the injection or possible side effects, please visit: https://www.medicines.org.uk/emc/product/2876/pil
Alternatively, please ask any member of the team for further details when you attend for your appointment.

As part of this process we do ask that you answer the following questions and then please sign below.

Confirm(Required)

I confirm that I have read the above information

Booking Reference

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Appointment Date / Time

MRI Summary

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Examination Requested

Final MRI Total

Price: £ 0.00

Coupon

Total

Card Payment(Required)