MRI / MEG Consent & Safety Screening Form

ALL individuals are required to fill out this form BEFORE entering the MRI and / or MEG environments.

In order to submit this form your Email Address and Date of Birth must match the data inputted by the referrer.

The MR system has a very strong magnetic field that may be hazardous to individuals entering the MRI environment if they have certain metallic, electronic, magnetic or mechanical implants, devices or objects.

MEG is very sensitive to large magnetic fields and could be damaged if any metal is placed nearby. Be advised, the MRI and MEG Scanner is ALWAYS on!

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    Step 2

    If you answer YES to any of the questions marked with an asterisk * please contact us as soon as possible: IHN Administrators Contact Number: 0121 204 3882 / Email:

    Step 3

    I have read and understood the contents of this form and confirm that the above information is correct to the best of my knowledge. I have had the opportunity to ask questions regarding the information on this form and consent to the MRI and / or MEG procedure.