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Patient Forms

Patient Forms

Click on the appropriate forms to download. Please print the form, fill it out and bring it with you to your appointment. Thank you!

 
Abdomen/Pelvis Evaluation Questionnaire Breast Imaging Questionnaire Chest Evaluation Questionnaire Consent For Contrast Administration DXA Scan Questionnaire Head / Neck / Spine Questionnaire
Lower Extremity Questionnaire Magnetic Resonance Imaging Contraindications Pelvic Ultrasound Questionnaire Upper Extremity Questionnaire Your Esophagram and/or Upper GI Series and/or Small Bowel Series
 

Schedule now for ALL of your Medical Imaging needs!

Patient Forms

Capital Imaging Associates is a Rezolut partner. Who is Rezolut?

Billing Inquiries

Pay By Phone:
(855) 202-0042

Hours of operation:
9:00 am to 9:00 pm EST

PATIENT BILLING PORTAL
Addresses:

1001 Loudon Road,
Latham, NY 12110
For GPS use 12047 zip code

3 Emma Ln.
Clifton Park, NY 12065

Phone:

(518) 785-7373

Fax:

(518) 786-8271

Patient Info:

Schedule an Online Appointment
Accepted Insurance


Latham Hours:

Monday - Friday: 7:00am - 5:00pm
Open Every Other Saturday

Clifton Park Hours:

Monday - Friday: 7:30am - 4:00pm

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