MRI/CT Scan Form

Health Plan

Complete this form if you have Basic or Comprehensive cover and require a CT or MRI Scan.
Upon receipt of this form Police Health Plan will confirm cover then send confirmation to the radiology clinic.

When emailing forms, documents or pictures:
Please use the attachment function to attach your jpeg, png or PDF to your email. Do not insert them into your email as this will delay processing.


If you are on our Surgical plan, and need a scan to determine whether you need surgery, you will need to pay for the scan.
If the scan leads to surgery and Health Plan approves cover for the procedure, you can be reimbursed for the costs.