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.  We've made these forms available online to print, fill out and bring with you to your appointment.  Doing so will help expedite your appointment and allow us to better serve you.

 

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.  On the remaining pages please list any changes; if there are NO CHANGES then write 'NO CHANGE' on each page and initial, sign and date.

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 complete the appropriate forms packet, fill out entirely, and either bring with you to your appointment or e-mail to This email address is being protected from spambots. You need JavaScript enabled to view it..

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.

NEW PATIENTS: Please complete these forms entirely and send them to This email address is being protected from spambots. You need JavaScript enabled to view it. PRIOR TO YOUR APPOINTMENT so that we may confirm you are medically eligible for this procedure.

RETURNING PATIENTS: Please only complete these forms if there have been changes in your medical status since your last visit.

This is a very important step it prepares us for your appointment!                      

 

 Lymphatic Medical Forms                            Click HERE to download

 

Physician Form


Click HERE to download

 

Notice of Privacy Policy


Click HERE to view

 

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