Schedule an Appointment

Please refer your patients to us using the forms below, and fax directly to our scheduling team for follow up.

They are able to discuss the details of our screening options with you should you have any questions.

• Fill out the MR Prostate Radiology Requisition Form.
• Fill out the MRI Safety Screening Questionnaire.
• Fax both forms to (310) 794-9035 "Attn: UCLA Prostate Imaging Program".

MR Prostate Radiology
Requisition Form

MRI Safety Screening
Questionnaire