Forms

Bone Densitometry Questionnaire

CT Contrast Consent

CT Contrast Consent

(Spanish)

Health History

Industrial Accident Form

Language Assistance Notice

MRI Patient ScreeningForm

MRI Patient Screening Form

(Spanish)

MRI Contrast Consent

Medical Records Release Form

Medicare Authorization Form

Motor Vehicle Accident Form

Notice of Non-Discrimination

Notice of Privacy Practices

Notice os Privacy Practices

(Spanish)

Notice of Privacy practices Receipt

Notice of Privacy Practices Receipt

(Spanish)

Patient Registration Form

Pregnancy Questionnaire

Pregnancy Questionnaire

(Spanish)

Request to Access PHI

Patient Discharge Instructions

Ablation Post-Procedure Instructions

Ablation Post-Procedure Instructions

(Spanish)

Biopsy Image Guided Discharge Instructions

Biopsy Image Guided Discharge Instructions

(Spanish)

Breast Biopsy Stereotactic US Guided Discharge Instructions

Breast Biopsy Stereotactic US Guided Discharge Instructions

(Spanish)

CT Discharge Instructions IV Contrast Extravasation

CT Discharge Instructions IV Contrast Reaction

ESI Discharge Instructions

ESI Discharge Instructions

(Spanish)

Foam Sclerotherapy Discharge Instructions

Foam Sclerotherapy Discharge Instructions

(Spanish)

Hysterosalpingogram Discharge Instructions

Hysterosalpingogram Discharge Instructions

(Spanish)

Implanted Chest Port Discharge Instructions

Implanted Chest Port Discharge Instructions

(Spanish)

Lumbar Puncture Discharge Instructions

Lumbar Puncture Discharge Instructions

(Spanish)

Myelogram Discharge Instructions

Myelogram Discharge Instructions

(Spanish)

Percutaneous Drain Discharge Instructions

Percutaneous Drain Discharge Instructions

(Spanish)

Phlebectomy Post-Procedure Instructions

Phlebectomy Post-Procedure Instructions

(Spanish)

PICC Line Placement Discharge Instructions

PICC Line Placement Discharge Instructions

(Spanish)

Port-a-Cath Discharge Instructions

Port-a-Cath Discharge Instructions

(Spanish)

Post Myelogram Instructions

Post Myelogram Instructions

(Spanish)

RF Nerve Ablation Discharge Instructions

RF Nerve Ablation Discharge Instructions

(Spanish)

Sclerotherapy Discharge Instructions

Sclerotherapy Discharge Instructions

(Spanish)

SI Joint Steriod Injection Discharge Instructions

SI Joint Steriod Injection Discharge Instructions

(Spanish)

Thyroid US-Guided Bx Discharge Instructions

Thyroid US-Guided Bx Discharge Instructions

(Spanish)

VenaSeal Post-Procedure Instructions

VenaSeal Post-Procedure Instructions

(Spanish)

Vertebroplasty Discharge Instructions

Vertebroplasty Discharge Instructions

(Spanish)

Quality is our image.

Located in both Idaho Falls and Rexburg!

Teton Radiology

2001 S. Woodruff Suite 17 Idaho Falls, ID

Phone: (208) 524-7237

Fax: (208) 522-3017

support@tetonradiology.com

Teton Radiology Madison

425 E. 4th N. Rexburg, ID

Phone: (208) 356-4888

Fax: (208) 356-4720

support@tetonradiology.com

Opening Hours

Monday:     8:00am - 5:00pm

Tuesday:     8:00am - 5:00pm

Wednesday:     8:00am - 5:00pm

Thursday:     8:00am - 5:00pm

Friday:     8:00am - 5:00pm