Print Forms | Diagnostic Medical Imaging

Patient Information

Helping with Your Care

Thank you for choosing SimonMed Imaging for your medical imaging. For your added convenience please use the links below.

For any additional questions, please call or text us at

1-866-614-8555 or email us.

Prep Instructions

Preparation Instructions to review before your exam.

Patient Information Form - English

Consent to Treat

Patient Information Form - Spanish

Consent to Treat

Medical Records Policy

Process of Requesting Medical Records

Medical Records Request Form - English

Authorization to Release PHI

Medical Records Request Form - Spanish

Authorization to Release PHI

Why Choose Us

SimonMed Imaging and its affiliates have been serving the community for over 30 years. Our mission is to provide best-in class affordable care through the use of advanced technology. We have patient-focused staff and highly trained medical professionals.

SimonMed has over 100 convenient locations and provides late night and weekend appointments to accommodate patients.

Prepare for Your Visit