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Forms

Home / Forms

Patient Information Forms

These forms are provided for your convenience. You may download and complete the form prior to your appointment. Please don’t forget to bring them with you.

Form Title English Spanish
History and Screening Download PDF (Opens PDF in new window) Download PDF (Opens PDF in new window)
CD/Film Request Download PDF (Opens PDF in new window) Download PDF (Opens PDF in new window)
Notice of Privacy Practices Download PDF (Opens PDF in new window) Download PDF (Opens PDF in new window)
Release of Information Authorization Download PDF (Opens PDF in new window) Download PDF (Opens PDF in new window)

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  • Bexar Imaging - Main
  • 25 NE Loop 410
  • Suite 121
  • San Antonio, TX 78216
  • 210-384-8439
  • Bexar Imaging - South
  • 7355 Barlite Blvd.
  • Suite 201
  • San Antonio, TX 78224
  • 210-806-9255
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