Patient Medical Forms

Thermography Medical Forms

It is standard practice that with each appointment our patients fill out health related questionnaires as well as HIPAA forms.  So as to expedite your appointments, we've made these forms available online to print, fill out, and bring with you to your appointment.  Since these forms can take 10-15 minutes to fill out, doing so before you come saves you and us that much time off of your appointment.


For New Patients:

Please fill out each page in it's entirety! Be sure to include as much of your medical history as you can recall in respect to the questions that are asked.

For Returning Patients ONLY!

Please Fill Out the HIPAA Form each time you come; it is the form that asks how you would like to receive your report and on the remaining pages if there are NO CHANGES. Write No change on each page initialing and signing and dating. If You have changes please list them accordingly.


Be sure to review and follow your appointment preparation instructions, which you can find here on our website or by clicking: Appt. Prep Instructions

Please print and fill out the appropriate forms packet, fill out entirely, and bring with you to your appointment.

Female Patient Forms

Click HERE to download

Male Patient Forms

Click HERE to download


Lymphatic Medical Forms

Lymphatic Medical Forms are not gender specific so both male and female can use these forms. Please Download, Print and Fill out entirely each page.

You can either Scan and email them back to This email address is being protected from spambots. You need JavaScript enabled to view it. or you can take pictures and Text them back to (251) 623-2225.

This is a very important step it prepares us for your appointment! Also Please bring your printed copy with you to your appointment.                     


 Lymphatic Medical Forms                            Click HERE to download


Physician Form

Click HERE to download