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Book Cardiac MRI

Phone (from 8.30 am to 4.30 pm): +41 91 640 40 40

Email: segretariato.cardioticino@hin.ch

Request form

Download the form, fill it in and attach it below.

Download the form (PDF)
If you are a physician, you can enter your GLN number. Secretaries may leave it empty.
Online form

Fill in the request

Fill in the fields below: at the end you download the PDF form already filled in, identical to the original, ready to attach to the email for the secretariat.

Request
Patient data
Requested examination
Symptoms
Therapy
Information
Allergies to contrast media (specify reaction)
Other allergies
Claustrophobia (hypnosis)
Carrier of intracardiac devices (PM/ICD/prosthesis or other)
Pregnancy or breastfeeding (women of childbearing age)
Insulin pump or sensor
Cataract with lens replacement (last 6 weeks)
To attach

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Centro Cardiologico Ticino, Via Pretorio 9, 6900 Lugano
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