Please print and complete the forms specific to your scheduled thermal imaging study. If you are unable to print the forms, we will have them available to fill out the day of your appointment. Plan to arrive 15 minutes prior to your appointment to complete all forms.

Patient Forms
How To Prepare For Your Thermography Scan (all patients) (PDF)
Patient Contact Information Form (all patients (PDF))
Patient Health History Form (all patients) (PDF)
HIPPA Authorization Form (all patients) (PDF)
Breast Thermography Questionnaire (PDF)
Extended Breast Thermography Questionnaire (for patients with a history of abnormal breast findings) (PDF)
Full Body Thermography Questionnaire (PDF)
Upper Body Thermography Questionnaire (PDF)
Lower Body Thermography Questionnaire (PDF)
Region of Interest Thermography Questionnaire (PDF)