AppointmentDateandTime:_______________________

3 Extremity X-Ray (Finger, Hand, Wrist, Forearm, Elbow, Humerus, Shoulder,

Toe, Foot, Ankle, Leg, Knee Femur Hip)
What is an extremity x-ray?

An extremity x-ray includes any of the exams that are listed above.

What should you tell us before the exam?

Tell us if you are pregnant.

What will happen in the x-ray room?

You may be asked to remove rings, watch and/or shoes. There are usually two to three images taken of the extremity.

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How do I prepare for this exam?

Follow the instructions your DOCTOR checked below:
Follow these standard instructions:
There is no preparation for this exam.
Your usual medication may be taken.

Follow these special instructions:

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DOCTORSSignature:_____________________________Date:_____________