Bucky & Your Research Visit
MRI Safety Slide Show for Child Research Participants
File: Lane-Lab-Bucky-and-Your-Research-Visit.pptxHERI
COVID-19 Exposure Screening
Print and give to MRI Team on day of scan.
File: Covid-Screening-Form-FILLABLE.pdfDay of Scan Information
Information and instructions to help subjects prepare for MRI scan
File: HERI_dayofscan_11_14_2019.pdfSurgical Implant Information Form
To be completed by MRI subject or physician and sent via FAX or MAIL only.
File: HERI_implant_FILLABLE.pdfSurgical Procedure Information Form
To be completed by MRI subject or physician and sent via FAX or MAIL only.
File: HERI_surgery_FILLABLE.pdfMRI Screening Form
To be completed by MRI subject or physician and sent via FAX or MAIL only.
File: HERI_MRI_Screening_1_22_25.pdfLane Neuroimaging Lab – Forms for MRI Subjects
The following forms should be completed by subject and/or physician. Upon completion, these forms will contain Protected Health Information and therefore should be submitted by fax or mail only (or handed directly to the Study Coordinator).
Please FAX completed forms to (608)238-1473 Attn: MRI Research
or MAIL to Lane Neuroimaging Lab - 6001 Research Park Blvd, Madison, WI 53719
The following forms should be completed by subject and/or physician. Upon completion, these forms will contain Protected Health Information and therefore should be submitted by fax or mail only (or handed directly to the Study Coordinator).
- MRI Screening Form
- Surgical Procedure Information Form
- Surgical Implant Information Form
- Day of Scan Information
Please FAX completed forms to (608)238-1473 Attn: MRI Research
or MAIL to Lane Neuroimaging Lab – 6001 Research Park Blvd, Madison, WI 53719