Appointments
Services / Modalities
Contact Us
Physican Portal
Patient Portal
Attorney

Menu

Appointments
Services / Modalities
Contact Us
Physican Portal
Patient Portal
Attorney

Appointments
Services / Modalities
Contact Us

Menu

Appointments
Services / Modalities
Contact Us

Physican Portal
Patient Portal
Attorney Portal

Menu

Physican Portal
Patient Portal
Attorney Portal

Consent of Disclosure

"*" indicates required fields

09/07/2024

Name*

First Last

Email*

MRN*

DOB*

MM slash DD slash YYYY

Consent 1*

I have been provided access to MRI Associates Notice of Privacy Practices. I understand that I am entitled to a copy of these practices at my request.*

Consent 2*

I furthermore acknowledge that I have the right to designate access to my Protected Health Information (PHI) to anyone of my choosing. I hereby authorize disclosure of my PHI to the following individual(s)*

Authorized Individual 1

Authorized Individual 2

Authorized Individual 3

Consent 3*

I understand I may revoke this authorization at any time by submitting a written request to MRI Associates Privacy Officer, as per the office’s Notice of Privacy Practices.*

Consent 4*

I understand that by signing this authorization,this information will be used by MRI Associates to make determinations for the release of my PHI. I also understand this authorization will remain in effect until I request an update and/or amendment.*

OUR FACILITIES

PALM HARBOR MRI
32615 US HWY 19 North
Palm Harbor, FL 34684

727.787.6900 P | 727.787.1892 F

Monday – Friday: 7 am to 10 pm
Saturday – Sunday: 8 am to 7 pm (MRI only)

HIGHLAND MRI
2946 Lakeland Highlands Road
Lakeland, FL 33803

863.510.5944 P | 863.510.5939 F

Monday, Wednesday, Thursday:
7 am to 8 pm
Tuesday: 7 am to 7 pm
Friday: 7 am to 6 pm

WINTER HAVEN MRI
409 East Central Avenue
Winter Haven, FL 33880

863.294.0999 P | 863.294.0010 F

Monday – Friday: 7 am to 8 pm

BRANDON MRI
403 South Kings Avenue
Suite 200
Brandon, FL 33511

813.210.8995 P | 813.409.2914 F

Monday – Saturday: 7 am to 7 pm
Extended Hours Available Upon Request

SARASOTA MRI
2 North Tuttle Avenue
Sarasota, FL 34237

941.951.1888 P | 941.951.1910 F

Monday – Friday: 7 am to 7 pm

BRADENTON MRI
5817 21st Avenue West
Suite B
Bradenton, FL 34209

941.567.4039 P | 941.567.4041 F

Monday – Friday: 8 am to 5 pm

VENICE MRI
1370 East Venice Avenue
Suite 101
Venice, FL 34285

941.484.6500 P | 941.484.6556 F

Monday – Friday: 8 am to 5 pm

VENICE MRI - Port Charlotte
21186 Olean Blvd.
Port Charlotte, FL 33952

941.289.0705 P | 941.237.5903 F

Monday – Friday: 8 am to 5 pm

Main Office:
PALM HARBOR MRI
32615 US Hwy 19 North
Palm Harbor, FL 34684
Phone: 727.787.6900
Fax: 727.216.4789

FACILITIES

Palm Harbor MRI
Highland MRI (Lakeland)
Winter Haven MRI
Brandon MRI
Sarasota MRI
Brandenton MRI
Venice MRI
Venice MRI-Port Charlotte

MODALITIES

High Field MRI
Wide Bore HF MRI
High Field Open MRI
Arthrograms
MRA | MRV
MRCP
Diffusion Tensor (DTI)

Susceptibility Weighted (SWI)
NeuroQuant
CT Scan | CTA
Echocardiograms
Ultrasounds
X-Rays
DEXA – Bone Density
3D Mammography
Health Screenings

QUICK LINKS

Schedule Appointment
Physician Access
Patient Access
Attorney Access
Insurances Accepted
Exam Preparation
Pay Your Bill
Contact Us

Staff Resources

Higher Technology For Better Patient Care

Copyright © 2023. All rights reserved. Powered by Skyline Graffix Inc.