thermography intake forms

Please read the Welcome Letter as it contains important information about your appointment.

Please print the Intake Form, fill it out and bring the form to your appointment.

VERMONT WELCOME LETTER

NEW YORK WELCOME LETTER

BREAST FORMS

Forms to fill out if you are having a Breast Thermography:

patient contact information form

breast thermography questionnaire

 region imaging questionnaire

WOMEN'S HEALTH FORMS

Forms to fill out if you are having a women's health thermography:

patient contact information form

breast thermography questionnaire

women's health thermography questionnaire

 region imaging questionnaire

FULL BODY FORMS

Forms to fill out if you are having a full body thermography:

patient contact information form

breast thermography questionnaire

(WOMEN ONLY)

full body region imaging questionnaire

Immune health scan

Forms to fill out if you are having an immune health scan:

patient contact information form

 region imaging questionnaire