Client Forms

Picture of Health & Thermography, LLC

Picture of Health & Thermography, LLC, located at 117 Broadfoot Avenue, Fayetteville, NC, in Suite 201 of the Haymount Heath & Wellness Building, offers medical thermography.

It is our belief that thermography is an important screening tool for both patients and physicians to help provide the best possible breast care and best possible care for many other medical issues in the body. This valuable screening tool has been available for some time in many physicians offices and hospitals in other areas of the country. We are proud to bring thermography to our community!

Please explore this web site to find out more.

What is a Thermogram, Anyway?
Click Here for Details!

Breast Thermography (DITI)
Part of your comprehensive breast care and prevention program.
Click here for details.

Thermography Image montage

Client Forms

Use the menu below to download forms to fill out and bring to your thermography appointment.

All Clients
Patient Information Form
Patient Authorization Form
Patient Consent Form
Patient Privacy Form

Breast Scan Only
Breast Thermogram Form
Form for Patients with a History of Breast Disease or Treatment

Full Body Scan With Breast
Full Body Thermogram Information Form
Breast Thermogram Form
Form for Patients with a History of Breast Disease or Treatment

Full Body Scan For Men
Full Body Thermogram Information Form

Upper Body Scan With Breast
Upper Body Thermogram Form
Breast Thermogram Form
Form for Patients with a History of Breast Disease or Treatment

Upper Body Scan Without Breast
Upper Body Thermogram Form

Lower Body Scan
Lower Body Thermogram Form

Region of Interest / Special Study
Region of Interest/Special Study Thermogram Form