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All new patients are required to fill out a Health History and a Breast Health History if you are a woman. For your convenience we have provided Adobe Acrobat pdf files below that you can download, print, and fill out prior to your appointment.
Please also read the Patient Instruction Sheet and follow the guidelines 2 days prior to your appointment.
If you need Adobe Acrobat Reader you can download it by clicking here.
Health History required for all new patients:
Health History page 1 (148k pdf),
Health History page 2 (96k pdf),
Health History page 3 (116k pdf)
Follow these instructions at least 2 days prior to your appointment:
Patient Instruction Sheet (88k pdf)
Breast Thermography Patients:
In addition to the Patient Instruction Sheet, please fill out and bring this Breast Health History form with you.
Breast Health History (112k pdf)
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