Medical Imaging Northwest | Downloadable Forms

Downloadable Forms

Below you will find our radiology order forms in PDF format. To view and/or print these forms, you will need Adobe Acrobat Reader, which can be downloaded from and used for free.

For patients being referred to our outpatint imaging sites:  Bonney Lake, Puyallup, or Sunrise (Puyallup), please use the referral form link to access the most up-to-date referral form.  To assure accuracy, this form should be completed and faxed to 253-446-3973 at least 48 hours before a scheduled procedure. For walk-in appointmennts, we encourage that the  referral form be faxed, as well as hand-carried (by the patient) to the appropriate Imaging Center

To download a referral form click here:

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