Patient Forms

Please download the appropriate forms, fill out and bring them with you to your appointment. If you do not know which forms you need to complete, contact our office.

  Extended Breast Health Questionnaire
» 199.4 KiB - 2,426 hits - June 15, 2013

  Full Body Study Questionnaire
» 653.0 KiB - 2,354 hits - June 26, 2013

  Lower Body Study Questionnaire
» 475.5 KiB - 2,026 hits - June 26, 2013

  Breast Thermography Questionnaire
» 637.6 KiB - 3,081 hits - June 5, 2013

  Patient Information Sheet
» 1.5 MiB - 2,593 hits - June 2, 2013

  Acknowledgement Receipt
» 233.0 KiB - 1,793 hits - July 1, 2013

  Authorization to Use or Disclose Information
» 175.2 KiB - 1,750 hits - July 1, 2013

  Notice of Privacy Practices
» 315.5 KiB - 1,839 hits - July 1, 2013

  Appointment Instructions
» 84.8 KiB - 1,784 hits - July 1, 2013

Early Detection Can Save Your Life ~ We Are The Only Facility In Gaston County With This Technology