Forms

Everything you need, all in one place! We have listed all the forms that you will need. Please feel free to download these forms directly from our website.

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Consent Forms

Please kindly download the appropriate form for your procedure, complete and send back to us via email.

Parklane Radiology:

info@plradiology.co.za

Women’s Imaging Centre:

bookings@plradiology.co.za

Kempton Park Mammography: 

marita@plradiology.co.za

Patient Jobcard

POPI Consent

Radiology Procedure

Cryoablation Procedure

Breast Related Procedure

Allergy To Contrast Media

Consent Forms

Please kindly download the appropriate form for your procedure, complete and send back to us.

Doctor referral forms

In order for us to obtain authorization, and process your patient’s examination efficiently, please provide a full history, including current complaint, relevant medical history and results of previous investigations. If you would like a verbal or urgent report on a patient, please indicate so on your referral form. Please feel free to phone our radiologists directly for advice on the most appropriate radiological studies for your patient.

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