Patient Info

Before your first appointment please print, review and complete the following forms:


  1. Patient Information Sheet
  2. New Patient Intake Form
  3. Privacy & Disclosure
  4. System & Medical History Review
  5. Full Body Questionnaire
  6. Breast Questionnaire
  7. Extended Breast Questionnaire

Please bring your completed forms with you to your scheduled appointment. If you have questions while completing these forms we will be happy to assist you when you arrive or contact us.

It is imperative that you provide as much health information as possible, including the paternal or maternal designations where appropriate. This aids the thermologist (a medical doctor certified by the board of ACCT) who interprets the scans to provide a thorough and accurate report. Additionally men do not need to complete the breast forms.