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Cardiac CT Angiography Questions Form

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Name*
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Have you ever had a CT scan with dye/contrast before?*
Have you ever had an anaphylactic reaction to anything?*
Do you have an allergy to Beta Blockers?*
Do you have an allergy to CT Contrast Dye?*
Do you have a personal history of limited kidney function?*
Are you diabetic?*
If yes - do you take Metformin?
Do you have a personal history of asthma?*
If yes – do you take daily medication for it?
This field is for validation purposes and should be left unchanged.
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