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Forms


In order to expedite your initial check-in, please print the appropriate forms and fill them out to the best of your ability. You may also sign the mammography film release to ensure that your previous films will be here for your first appointment. Please fax it to 231.439.9709 or simply drop it off to our office. We'll take care of the rest!

These forms are in PDF format and are available to download and print with the use of the FREE Adobe Reader or other PDF file application. If you experience any issues opening the files, please download and install Adobe Reader from Adobe.com.

Patient Registration Form
Mammography Film Release - Petoskey Office
Mammography Film Release - Gaylord Office
Venous Medical History
Vein Procedure Instructions
Pre-Procedure Instructions for Vein Patients


Image North Petoskey
1114 Charlevoix Avenue
Petoskey, MI 49770
Phone: 231.439.9700
Fax: 231.439.9709
Image North Gaylord
2922 D&M Drive
Gaylord, MI 49735
Phone: 989.705.1100
Fax: 989.705.1104
Solo io
2922 D&M Drive
Gaylord, MI 49735
Phone: 989.705.1100
Fax: 989.705.1104
Web: www.soloio.org
Image North Advanced Radiology Specialists Physician Login