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Please select the type of scan
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MRI
Open or Upright MRI Scan
CT scan
Colonoscopy
CT Angiogram one part
MRA One Part
Specialist Scans Mp Prostate
Cardiac MRI scan
XR One Part
USS One Part
Please select the location for your MRI scan
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Ashford, Surrey
Bancyfelin, West Wales
Belfast, Northern Ireland
Bolton, Greater Manchester
Bradford, Leeds, West Yorkshire
Bridgwater, Somerset
Canary Wharf, London
Cannock, West Midlands
Chertsey, Surrey
Cockermouth, Cumbria
Colchester, Essex
Enfield, London
Epsom, Surrey
Glasgow, Scotland
Guildford, Surrey
Harley Street, Marylebone, London
Hartlepool, Durham
Haywards Heath, West Sussex
Hendon, London
Isleworth, London
Leicester, East Midlands
Leigh on Sea, Essex
Louth, Lincolnshire
Lytham St Annes, Lancashire
Manchester
Marylebone, London
Middlesbrough, North Yorkshire
MRI Scan – Manchester
Newcastle upon Tyne,Tyne and Wear
Newton-Le-Willows, Merseyside
Northampton, East Midlands
Northwood, London
Orpington, Kent
Oulton, Leeds, West Yorkshire
Penrith, Cumbria
Plymouth, Devon
Preston, Lancashire
Pudsey, Leeds, West Yorkshire
Sheffield, South Yorkshire
Sidcup, Kent
Skegness, Lincolnshire
Sleaford, Lincolnshire
Southampton (SO14), Hampshire
Southampton, Hampshire
Spalding, Lincolnshire
St Helens, Merseyside
St Helens, Merseyside MP prostate
Stockport, Greater Manchester
Stockton-on-Tees, Durham
Taunton, Somerset
Truro, Cornwall
Wigan, Greater Manchester
Wythenshawe, Manchester (M22)
Wythenshawe, Manchester (M23)
Westcliff-on-Sea
Please select the location for your CT scan
:
Please complete
Ashford, Surrey
Bancyfelin, West Wales
Belfast, Northern Ireland
Bolton, Greater Manchester
Bradford, Leeds, West Yorkshire
Bridgwater, Somerset
Canary Wharf, London
Cannock, West Midlands
Chertsey, Surrey
Cockermouth, Cumbria
Colchester, Essex
Enfield, London
Epsom, Surrey
Glasgow, Scotland
Guildford, Surrey
Harley Street, Marylebone, London
Hartlepool, Durham
Haywards Heath, West Sussex
Hendon, London
Isleworth, London
Leicester, East Midlands
Leigh on Sea, Essex
Louth, Lincolnshire
Lytham St Annes, Lancashire
Manchester
Marylebone, London
Middlesbrough, North Yorkshire
MRI Scan – Manchester
Newcastle upon Tyne,Tyne and Wear
Newton-Le-Willows, Merseyside
Northampton, East Midlands
Northwood, London
Orpington, Kent
Oulton, Leeds, West Yorkshire
Penrith, Cumbria
Plymouth, Devon
Preston, Lancashire
Pudsey, Leeds, West Yorkshire
Sheffield, South Yorkshire
Sidcup, Kent
Skegness, Lincolnshire
Sleaford, Lincolnshire
Southampton (SO14), Hampshire
Southampton, Hampshire
Spalding, Lincolnshire
St Helens, Merseyside
St Helens, Merseyside MP prostate
Stockport, Greater Manchester
Stockton-on-Tees, Durham
Taunton, Somerset
Truro, Cornwall
Wigan, Greater Manchester
Wythenshawe, Manchester (M22)
Wythenshawe, Manchester (M23)
Westcliff-on-Sea
You have selected a MRI scan . How many parts of the body do you need scanned?
:
One Part MRI scan
Two Part MRI scan
Three Part MRI scan
Four Part MRI scan
You have selected a MRI scan . How many parts of the body do you need scanned?
:
One Part MRI scan
Two Part MRI scan
Three Part MRI scan
Four Part MRI scan
You have selected a MRI scan . How many parts of the body do you need scanned?
:
One Part MRI scan
Two Part MRI scan
Three Part MRI scan
Four Part MRI scan
You have selected a MRI scan . How many parts of the body do you need scanned?
:
One Part MRI scan
Two Part MRI scan
You have selected a MRI scan . How many parts of the body do you need scanned?
:
One Part MRI scan
Two Part MRI scan
Three Part MRI scan
You have selected a MRI scan . How many parts of the body do you need scanned?
:
One Part MRI scan
Two Part MRI scan
Three Part MRI scan
You have selected a MRI scan . How many parts of the body do you need scanned?
:
One Part MRI scan
Two Part MRI scan
Three Part MRI scan
Four Part MRI scan
You have selected a MRI scan . How many parts of the body do you need scanned?
:
One Part MRI scan
Two Part MRI scan
Three Part MRI scan
Four Part MRI scan
You have selected a CT scan. How many parts of the body do you need scanned?
:
One Part CT scan
You have selected a CT scan. How many parts of the body do you need scanned?
:
One Part CT scan
You have selected a CT scan. How many parts of the body do you need scanned?
:
One Part CT scan
Two Part CT scan
Three Part CT scan
Four Part CT scan
You have selected a CT scan. How many parts of the body do you need scanned?
:
One Part CT scan
Two Part CT scan
Three Part CT scan
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Please provide some additional information, so our medical team can provide a referral for your scan:
Thank you for your payment.
Please provide some additional information, and upload your referral letter:
GP name / Doctor's name
:
Surgery name
:
Legal guardian
Mobile number
:
Gender
Female
Male
Height/units
Weight/units
First body area
:
Full Body Scan
Abdomen
Brain/Head
Breasts (Both)
Calf-Left
Calf-Right
Chest - CT scan
Coccyx
Ankle-Left
Ankle-Right
Elbow-Left
Elbow-Right
Facial Bones
Femur-Left
Femur-Right
Foot-Left
Foot-Right
Forearm-Left
Forearm-Right
Groin
Hand-Left
Hand-Right
Hip-Left
Hip-Right
IAMs (Both)
Knee-Left
Knee-Right
Lower Back (Lumbar Spine)
Middle Back (Thoracic Spine)
Neck (Cervical Spine)
Orbits
Pelvis for organs
Pelvis musculoskeletal
Pituitary
Prostate
Prostate Multiparametric
Sacroiliac Joints
Scrotum
Shoulder-Left
Shoulder-Right
Sinus
Sternoclavicular Joint
Thigh-Left
Thigh-Right
TMJ-Left
TMJ-Right
Upper Arm-Left
Upper Arm-Right
Whole body scan - London
Wrist-Left
Wrist-Right
How long have you been complaining of symptoms in first body area?
:
less than 1 month
1 - 3 months
3 - 6 months
6 months or more
(period)
What symptoms do you have in the first body area?
:
Difficulty in moving
Dull ache
Feeling generally unwell
Headache
Limitation of movement
Limping
Numbness
Pain - sharp
Pins and Needles
Stiffness
Swelling
Weakness
Please provide details
Second body area scan
:
Full Body Scan
Abdomen
Brain/Head
Breasts (Both)
Calf-Left
Calf-Right
Chest - CT scan
Coccyx
Ankle-Left
Ankle-Right
Elbow-Left
Elbow-Right
Facial Bones
Femur-Left
Femur-Right
Foot-Left
Foot-Right
Forearm-Left
Forearm-Right
Groin
Hand-Left
Hand-Right
Hip-Left
Hip-Right
IAMs (Both)
Knee-Left
Knee-Right
Lower Back (Lumbar Spine)
Middle Back (Thoracic Spine)
Neck (Cervical Spine)
Orbits
Pelvis for organs
Pelvis musculoskeletal
Pituitary
Prostate
Prostate Multiparametric
Sacroiliac Joints
Scrotum
Shoulder-Left
Shoulder-Right
Sinus
Sternoclavicular Joint
Thigh-Left
Thigh-Right
TMJ-Left
TMJ-Right
Upper Arm-Left
Upper Arm-Right
Whole body scan - London
Wrist-Left
Wrist-Right
Second body area symptoms
:
How long have you been complaining of symptoms in second body area?
less than 1 month
1 - 3 months
3 - 6 months
6 months or more
(period)
Third part body area scan
:
Full Body Scan
Abdomen
Brain/Head
Breasts (Both)
Calf-Left
Calf-Right
Chest - CT scan
Coccyx
Ankle-Left
Ankle-Right
Elbow-Left
Elbow-Right
Facial Bones
Femur-Left
Femur-Right
Foot-Left
Foot-Right
Forearm-Left
Forearm-Right
Groin
Hand-Left
Hand-Right
Hip-Left
Hip-Right
IAMs (Both)
Knee-Left
Knee-Right
Lower Back (Lumbar Spine)
Middle Back (Thoracic Spine)
Neck (Cervical Spine)
Orbits
Pelvis for organs
Pelvis musculoskeletal
Pituitary
Prostate
Prostate Multiparametric
Sacroiliac Joints
Scrotum
Shoulder-Left
Shoulder-Right
Sinus
Sternoclavicular Joint
Thigh-Left
Thigh-Right
TMJ-Left
TMJ-Right
Upper Arm-Left
Upper Arm-Right
Whole body scan - London
Wrist-Left
Wrist-Right
Third body area symptoms
:
How long have you been complaining of symptoms in third body area?
less than 1 month
1 - 3 months
3 - 6 months
6 months or more
(period)
Fourth part body area scan
:
Full Body Scan
Abdomen
Brain/Head
Breasts (Both)
Calf-Left
Calf-Right
Chest - CT scan
Coccyx
Ankle-Left
Ankle-Right
Elbow-Left
Elbow-Right
Facial Bones
Femur-Left
Femur-Right
Foot-Left
Foot-Right
Forearm-Left
Forearm-Right
Groin
Hand-Left
Hand-Right
Hip-Left
Hip-Right
IAMs (Both)
Knee-Left
Knee-Right
Lower Back (Lumbar Spine)
Middle Back (Thoracic Spine)
Neck (Cervical Spine)
Orbits
Pelvis for organs
Pelvis musculoskeletal
Pituitary
Prostate
Prostate Multiparametric
Sacroiliac Joints
Scrotum
Shoulder-Left
Shoulder-Right
Sinus
Sternoclavicular Joint
Thigh-Left
Thigh-Right
TMJ-Left
TMJ-Right
Upper Arm-Left
Upper Arm-Right
Whole body scan - London
Wrist-Left
Wrist-Right
Fourth part body area symptoms
:
How long have you been complaining of symptoms in fourth body area?
less than 1 month
1 - 3 months
3 - 6 months
6 months or more
(period)
Please provide more details
Referral letter
Surgery/Clinic name
Surgery/Clinic phone if available
Please upload here the referral letter file
:
Drop files here or
Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 100 MB.
Please note the referral letter should:
be issued by a registered GP, Doctor, Consultant, Specialist, Physiotherapist or Osteopath;
contain the patient’s full name and date of birth;
specify the indications or symptoms, the type of scan requested and the body area(s) to be scanned;
be signed and show the GMC or other registered number of the referring party.
Other medical information
Please answer the questions below:
Have you had any surgery in the last 8 weeks?
Do you have a cardiac pacemaker?
Do you have any metal implants or prostheses?
Do you have any metal fragments in the eye?
Are you pregnant?
Are you breast feeding?
Do you suffer from claustrophobia?
Do you have an aneurism clip?
Do you have any of the following:
Allergies
Asthma
Depression
Diabetes
Epilepsy
Heart disease
High blood pressure
Do you have a cochlear implant or neurotransmitter?
Do you have a programmable ventriculoperitoneal shunt?
Do you have kidney/renal impairment?
Have you seen a GP or Consultant regarding this problem?
:
Yes
No
Please provide details
Are you in good general health?
:
Yes
No
Please provide details
Have you had any injuries or accidents?
:
Yes
No
Please provide details
Have you had any operations or scans?
:
Yes
No
Please provide details
Are you taking any medication or tablets?
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Yes
No
Please provide details
Other relevant details or family history:
Do you have any comments or special requests?
By submitting this form
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I agree to Secure Scanners
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I also consent to my symptoms and medical history being reviewed by the medical team who may contact me for further details and will recommend an appropriate scan or test.
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Secure Scanners Limited | MRI Scan, CT Scan, Full Body Scan
