If you are having breast thermography please print off and complete the breast questionnaire prioir to your appointment, alternatively we can complete one in person during your visit.
Breast Questionnaire
Please fill it in before arriving for your breast scan. Make sure you have read the Patient Scan preparation guide (top of page)
Breast Confidential Questionnaire.pdf
Adobe Acrobat document [94.7 KB]
Please fill it in before arriving for your breast scan. Make sure you have read the Patient Scan preparation guide (top of page)
Breast Confidential Questionnaire.pdf
Adobe Acrobat document [94.7 KB]
Region of Interest Questionnaire
It is helpful if you can fill out as much information regarding the location and nature of the pain, or symptoms, your medical history and any medications you take.
ROI Confidential Questionnaire.pdf
Adobe Acrobat document [121.5 KB]
It is helpful if you can fill out as much information regarding the location and nature of the pain, or symptoms, your medical history and any medications you take.
ROI Confidential Questionnaire.pdf
Adobe Acrobat document [121.5 KB]
Print 