HIRC Questionnaire / Service Request

Please fill out this form to request HIRC services and/or research imaging. All submissions will be assessed for feasibility. After submitting this form, you will receive a follow-up communication from the HIRC. An MOU signed by the PI and billing index are required for feasibility reviews and budget estimates.


Please note that feasibility is limited at this time due to current clinical demand for radiology services. We apologize for this inconvenience.

Please enter the primary investigator's email

UNM HSC IRB Status*
Has this study been submitted to the UNM HSC Sponsored Projects Office through Click Grants?*

Services Requested



Imaging Requested

Please check all modalities included in the study.


If the study materials include a radiology/imaging manual or any documents with specifications related to imaging, please attach at the end of the form.

Or project number of participants who will require imaging, if different.

Estimates and ranges are okay; if unsure or no timeline, please indicate "n/a."


If yes, please indicate which procedures are clinical standard of care


Comments & Additional Information

If you have any additional comments, questions, or requests, including any information you believe would be relevant to the HIRC feasibility assessment, please describe below.



Please upload any IRB protocols, sponsor-provided documents, questionnaires, or imaging manuals.


Too much information is better than not enough! This helps the HIRC to accurately assess the appropriate services for this study.

Drag and drop files here or