The MRI Request Form accessible from the link below is PDF writeable and has been developed as a preferred method for referring physicians to submit requests. This copy enables the user to type directly into the requisition, improving overall legibility and completeness.  

Please note that due to privacy concerns, we are currently unable to accept completed electronic requests by email and ask that you print, sign and fax all MRI Request forms. To ensure privacy standards, only blank copies of this electronic version can be saved. 

  • MRI Request FormPDF Icon
  • Prior to completing and submitting the MRI Request form please review the following documents:

  • Reference Sheet for MRI ScansPDF Icon
  • Highlights how each component of the MRI request form provides key information to help us serve your patient.

  • MRI Rejection CriteriaPDF Icon
  • The bookings department will reject any MRI that is illegible or unclear. Requisitions that are either missing information or illegible will be faxed back to the originating address with no resulting appointment date. 

    Learn more about MRIs at UHN.