Print Patient Forms and Instructions

Print your patient forms ​t​o complete and sign prior to your appointment.​

New Patients will need to fill out the Client Information, Breast Questionnaire (except men) and Authorization forms. 

Existing patients only need to update any new information since their last screening by using the Client Information form.

Authorization to Use or Disclose Protected Health Information

Client Information Form

      Confidential Breast Thermography Questionnaire

New and existing patients will need to download and carefully read through the Thermographic Preparation Information before a Breast Screening or Full Body Scan procedure.

Client Preparation - Breast and Full Body

All forms are also available at our office locations.

Schedule your safe and natural thermal breast scan or full body scan today and achieve peace of mind ... 

Thermography can detect early signs of the development of disease in the body such as formation of tumors and breast cancer as well as periodontal and heart disease. Thermal imaging scans performed with experience and expertise can allow you to identify and understand potential health issues today rather than years from now when it can be too late to treat.

Contact us today at 805-560-7602 to schedule your appointment and achieve the peace of mind that comes with early health awareness and prevention.


Disclaimer: The content on this page and on this website is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek out the advice of your physician or other qualified health care provider with any concerns you may have regarding a medical condition. Never disregard professional medical advice or delay seeking professional medical advice because of any information you have read on this website.