PATIENT PRE-SCAN INSTRUCTIONS: (Scroll down for required patient forms)
Thermology of Thermal Imaging is an evaluation of the levels, patterns and behavior of the skin’s temperature. To achieve a meaningful evaluation, you should avoid conditions that would cause artificial influences. Please fill out your patient history forms prior to your appointment and contact our office with any questions you might have that are not covered here.
- Unless specifically instructed by your physician, you should wait at least three (3) months after any form of breast surgery (including biopsy), the completion of chemotherapy or radiation before your study.
- You should avoid any natural or artificial tanning of your chest for three (3) days prior to your study.
- You must avoid any vigorous physical stimulation, examination or compression of the breasts (self or clinical examination, ultrasound or mammogram) for at least three (3) days prior to your study.
- You must not have had significant fevers (102° or more) within thirty-six (36) hours of your study or have any level of fever on the day of your study.
- You should refrain from a sauna, steam-room or hot/cold packs in contact with your breasts for at least twenty-four (24) hours prior to your study.
- There should be no new bruising, rashes or skin irritation on your breasts or underarms on the day of your study.
- You should not use any skin creams, lotions, deodorants or powders that may cause inflammation on your breasts or underarms on the day of your study.
- With your physician’s permission, please do not use the following medications for twelve (12) hours prior to your study: niacin or niacin patch (500 milligrams or more), nitroglycerin or any migraine medication.
- You should avoid any tobacco use or caffeinated coffee or tea consumption for two (2) hours prior to your study.
- You should avoid vigorous exercise, bathing or showering for one (1) hour prior to your study.
- If you are breast-feeding, please empty your breasts 30-60 minutes prior to your study.
- You may not wear any small necklaces
- Long hair should be worn up or pulled back off your shoulders prior to being scaned.
- For your comfort, we recommend you wear a blouse and pants or skirt to your study.
- If you are having a breast scan please do not wear a Bra to exam . You may bring one with you for after exam.
This may seem like a lengthy list of conditions to avoid. However, we have determined that each of them has the potential to decrease the reliability of your study. Please contact us to reschedule your appointment if you have compromised these conditions to avoid. We would rather reschedule you to another appointment date than redo your study. If you haven’t received your history form(s) in the mail after making your appointment, you may download and print the form(s) from this website.
Please download, print and complete the appropriate forms and bring them with you for your first appointment. (No medical referral required.)
Patients Must Complete the HIPAA Patient Authorization form prior to appointment:
- Pre-Study Instructions
- NETMIC – HIPPA – Patient Authorization Form
- What You Can Expect
- New Client Intake Form
Now Select Which Screening you are having and print/complete appropriate form:
Full Body Studies:
- Men’s Full Body Form
- Women’s Full Body Form
- Men’s Health Screening Form
- Women’s Health Screening Form
Upper Body Studies:
Region of Interest Studies:
Please call our office at 518-983-6564 with any questions as to which form to fill out.