Patient Intake Form

Online Patient Intake Form

Please read the Mandatory Protocols for Thermal Imaging

Mandatory Protocols for Thermal Imaging

Patient Preparation:

Thermal imaging is a heat sensitive test. Anything which creates heat should be avoided prior to testing. Excessive metabolic activity, friction, or any of the activities listed below which will alter heat readings.

1 Month Prior:

  • No minor breast surgery, i.e. biopsy
  • We may still perform testing after biopsy. Write this in form.

1 Week Prior:

  • Be cautious of too much sun exposure in order to avoid sunburn. Scans will have to be rescheduled if the patient has a sunburn of any sort.

48 Hours Prior:

  • Men with beards should shave their face and neck, as well as backs
  • Avoid all tanning and limit sun exposure

24 Hours Prior:

  • Avoid chiropractic care, massage therapy or acupuncture
  • No saunas, steam baths, hot tubs, heating pads, or hot water bottles
  • No analgesic creams or balms
  • Do not shave underarms (Should be done prior)
  • Reschedule if you experience a significant fever
  • Refrain from sexual activity

Day of Exam:

  • For best results, please wear thong underwear or a jock strap for full body studies. Underwear is optional and best results are without.
  • Do not use creams, lotions, cosmetics, ointments, deodorant, antiperspirants, powders or any other skin product
  • Please bring a hair tie to remove hair from your forehead and back of neck
  • Remove all piercings and jewelry prior to exam, unless unable to.

4 Hours Prior:

  • Avoid hot showers or shaving
  • Avoid physical therapy or exercise
  • No coffee, tea, soda, or other beverages containing caffeine. No alcoholic beverages.
  • Do not smoke cigarettes or use any product which contains nicotine

Women- do not wear a bra for the 4 hours leading up to the exam 2 Hours Before the Exam:

  • Avoid hot or cold liquids
  • Avoid eating or chewing gum
  • Avoid using a cell phone

Prior to and During Exam:

  • Please inform us if you have a hot flash during the session
  • Try to relax prior to and during the exam. Stress will affect your exam.