Referrals

Your online e-referral options

FMIG offer e-referrals for clinics. Please contact your Medical Liaison Officer to be set-up for e-referrals.

FMIG General Radiology request form

Please use this form for all general radiology requests including X-Ray, Ultrasound, CT scan, Doppler, MRI, Mammograms, injections, procedures, etc.

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FMIG General Radiology request form A5 pad size

Please use this form for all general radiology requests including X-Ray, Ultrasound, CT scan, Doppler, MRI, Mammograms, injections, procedures, etc.

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FMIG Radiology Telehealth referral form

For an editable Telehealth referral form please

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FMIG Cardiac Consult and Imaging request form

Please use this form for referring for a Cardiac CT Angiogram, Calcium scoring, Echocardiogram, Nuclear MIBI Scan, Cardiac Perfusion Imaging, etc.

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FMIG Cardiac MRI request form

Please use this form for referring for Cardiac MRI.

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FMIG MRI patient questionaire in Kiswahili language

This form contains the standard questions which are asked before an MRI scan in Kiswahili language.

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FMIG Dental radiology request form

Please use this form for referral for OPG, TMJ, Cephalograms, CT Dentascans, etc.

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