Get ready for your MRI: printable checklist

Nothing you type leaves your device; the hospital will screen you again.

The hospital or imaging center has its own safety form, and it will ask you again on the day. This checklist just helps you gather the answers ahead of time, so the real form goes faster. Fill it in on your phone or computer, then press Print (or save as PDF) and bring it. This page does not save what you type, so if you close or refresh it, it is gone. Your browser or printer may keep a copy of anything you print or save as PDF. If you use a shared computer, press Clear everything when you are done.

The questions are based on the American College of Radiology's public MR safety materials, including its sample MR safety screening form, (Source: ACR Manual on MR Safety (PDF)) and the RadiologyInfo.org MRI safety page. (Source: RadiologyInfo.org (RSNA/ACR): MRI Safety) Facilities may use different forms. (Source: ACR Manual on MR Safety (PDF)) If you are not sure about an answer, choose "Not sure" and tell the technologist. Leave out anything you do not want to write down; you can tell the staff in person.

Not medical advice. This page is general information from public sources. Your care team and the imaging center decide what is right for you or your child, and the facility's own rules come first. If something here does not match what your hospital tells you, follow the hospital and let us know.

Checklist for an adult or teen

Past scans and surgery

Have you had an MRI before?
Have you had any surgery or medical procedure?

Metal and injuries

Have you ever been hurt by a metal object, like a bullet, BB or shrapnel?
Have you ever hurt an eye with a piece of metal?

Implanted devices (in the body now, or removed)

Do you have any electronic, mechanical or magnetic implant?
Do you have a pacemaker, defibrillator or other heart implant?
Do you have an aneurysm clip?
Do you have a nerve or brain stimulator (for example deep brain, vagus nerve or spinal cord)?
Do you have any internal electrodes or wires?
Do you have a cochlear implant or any other ear implant?
Do you have an implanted drug pump (for example insulin or pain medicine)?
Do you have an artificial heart valve?
Do you have a coil, filter or stent in a blood vessel?
Do you have a shunt?
Do you have an IV access port (for example a Port-a-Cath or PICC line)?
Do you have a spinal fixation device?
Do you have pins, rods, screws, nails, plates or wires from surgery?
Do you have surgical clips or staples?
Do you have an artificial limb?
Do you have a tissue expander?
Do you have an artificial eye, or an eyelid spring or weight?
Do you have any implant that is held in place by a magnet?
Do you have an IUD or surgical mesh?

Things on or with your body that can come off

Do you wear a hearing aid?
Do you use a removable pump, like an insulin pump?
Do you wear a medication patch?
Do you have removable dentures, false teeth or a partial plate?
Do you have braces or dental work?
Do you have body piercings or wear jewelry?
Do you have tattoos or tattooed eyeliner?
Do you wear hair clips, barrettes, extensions or a wig?
Do you wear a fitness tracker or other electronic monitor?

Health, allergies and contrast

Do you have any allergies?
Have you ever had a reaction to contrast dye (for CT, MRI or X-ray)?
Do you have kidney disease, kidney failure, a kidney transplant or liver disease?
Do you take any medicines?

Pregnancy and breastfeeding

Is there any chance you are pregnant?
Are you breastfeeding?

Comfort

Do you feel scared or closed in when in small spaces?
Things to ask the MRI team about (check any)

Checklist for a child (parent version)

About your child

Has your child had sedation or anesthesia for a scan before?
Has your child been sick recently (fever, cold, vomiting)?

If your child is sick before the appointment, call your care team.

Do you want to ask about child life help or a practice (mock) scanner?

Your child: Past scans and surgery

Has your child had an MRI before?
Has your child had any surgery or medical procedure?

Your child: Metal and injuries

Has your child ever been hurt by a metal object, like a bullet, BB or shrapnel?
Has your child ever hurt an eye with a piece of metal?

Your child: Implanted devices (in the body now, or removed)

Does your child have any electronic, mechanical or magnetic implant?
Does your child have a pacemaker, defibrillator or other heart implant?
Does your child have an aneurysm clip?
Does your child have a nerve or brain stimulator (for example deep brain, vagus nerve or spinal cord)?
Does your child have any internal electrodes or wires?
Does your child have a cochlear implant or any other ear implant?
Does your child have an implanted drug pump (for example insulin or pain medicine)?
Does your child have an artificial heart valve?
Does your child have a coil, filter or stent in a blood vessel?
Does your child have a shunt?
Does your child have an IV access port (for example a Port-a-Cath or PICC line)?
Does your child have a spinal fixation device?
Does your child have pins, rods, screws, nails, plates or wires from surgery?
Does your child have surgical clips or staples?
Does your child have an artificial limb?
Does your child have a tissue expander?
Does your child have an artificial eye, or an eyelid spring or weight?
Does your child have any implant that is held in place by a magnet?
Does your child have surgical mesh?

Your child: Things on or with your body that can come off

Does your child wear a hearing aid?
Does your child use a removable pump, like an insulin pump?
Does your child wear a medication patch?
Does your child have removable dental plates or retainers?
Does your child have braces?
Does your child have body piercings or wear jewelry?
Does your child have tattoos or tattooed eyeliner?
Does your child wear hair clips, barrettes, extensions or a wig?
Does your child wear a fitness tracker or other electronic monitor?

Your child: Health, allergies and contrast

Does your child have any allergies?
Has your child ever had a reaction to contrast dye (for CT, MRI or X-ray)?
Does your child have kidney disease, kidney failure, a kidney transplant or liver disease?
Does your child take any medicines?

If a parent will be in the scan room

Anyone who may be present during the MRI must also remove metal and fill out a screening form. (Source: RadiologyInfo.org (RSNA/ACR): MRI Safety) Answer these for yourself:

Do you have a pacemaker, other implant or metal in your body?
Is there any chance you are pregnant?

Your child's comfort

Is your child ever worried or uncomfortable in small spaces?
Things to ask the MRI team about (check any)

Remember on the day

Nothing you type leaves your device; the hospital will screen you again. This is not a medical form and is not medical advice.

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