Nuclear Medicine

Request Forms (for the prescribing doctors)

You can download or print the following documents :

• Nuclear Medicine (conventional isotopes)
  Request for a nuclear medicine examination (pdf format)
  (French and Dutch)
   
• PET/CT (Fluor18 - FDG)
  Request for a PET/CT Scan examination (Word format)
  (choice at the bottom of the page: French or Dutch)
   
• PET/CT (Gallium 68 – Octreotide)
  Request for a PET/CT Gallium 68 - Octreotide examination (Word format)
  (choice at the bottom of the page: French or Dutch)
   
• PET/CT (Gallium 68 – PSMA)
  Request for a PET/CT Gallium 68 - PSMA examination
  (choice at the bottom of the page: French or Dutch)