Forms & Instructions

Review these important instructions first! There are some things you must avoid in order to have an accurate reading. Feel free to call us at 281-803-5880 if you need to discuss specifics.

Click below on the type of appointment you are scheduled for and the appropriate forms will appear. These forms are to be filled in online. If you prefer to print your forms, please click below.

Fill in the forms online and submit them.  If you prefer to print them and fill them out, please contact us at 281-803-5880 and we would be happy to email forms to you!

Appointment Forms
 
Every appointment for thermography imaging requires corresponding forms, including clients that are returning for annual or baseline screenings. Our office staff is ready to assist if you are unsure of which forms correspond to the imaging service you selected, simply give us a call at 281-803-5880.
THE FORMS BELOW ARE FILLABLE PDF FORMS.  If you are unable to fill out the forms or would prefer to print them out and fill them out yourself, please click on the link below for printable forms.
 
 
 
Full Body Thermogram
Includes head, neck, chest/breast, back, abdomen, upper and lower extremities.
 
 
 
 
Upper Body Thermogram
Includes head, neck, chest/breast, back, abdomen, and upper extremities.
This is the second-best option to the Full Body, because it still includes the majority of the body.
Breast Thermogram
Multiple views of the breast area, including the upper chest and underarm regions are evaluated.
 
Region of Interest Thermogram
This option is for those who would like to evaluate one particular area (does not apply to breast region), such as the thyroid, lower back, or abdomen. Please contact our office to discuss your particular needs and we will determine which forms are appropriate for your appointment.
 

Need Assistance?  Call (281) 803-5880

Call us today at 281-803-5880

Address: 13644 Breton Ridge Street, Suite E  -  Houston, TX  77070

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The editors, and contributors shall have no liability, obligation or responsibility to any person or entity for any loss, damage, or adverse consequence alleged to have happened directly or indirectly as a consequence of this material. Breast thermography offers women information that no other procedure can provide. Breast thermography is not a replacement for mammography or any other form of breast imaging. Breast thermography is meant to be used in addition to mammography and other tests. Breast thermography and mammography are complementary procedures, one does not replace the other. All thermography reports are meant to identify thermal emissions that suggest potential risk markers only and do not in any way suggest diagnosis and/or treatment. According to studies, earliest detection is realized when multiple tests are used together. This approach includes breast self-examinations, physical breast exams by a doctor, mammography, ultrasound, MRI, thermography, and other tests that may be ordered by your physician.

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