Loading...

Mandatory Protocols for Thermal Imaging

Thermal imaging is a heat sensitive test. Anything which creates heat should be avoided prior to testing. Excessive metabolic activity, friction, or any of the activities listed below which will alter heat readings.

1 Month Prior:

 No minor breast surgery, i.e. biopsy

 We may still perform testing after biopsy.


1 Week Prior:

 Be cautious of too much sun exposure in order to avoid sunburn. Scans will have to be rescheduled if the patient has a sunburn of any sort.

48 Hours Prior:

 Women should shave under arms/Men with beards should shave their face,neck,and back if needed.

 Avoid all tanning and limit sun exposure

24 Hours Prior:

 Avoid chiropractic care, massage therapy or acupuncture

 No saunas, steam baths, hot tubs, heating pads, or hot water bottles

 No analgesic creams or balms

 Do not shave underarms (Should be done prior)

 Reschedule if you experience a significant fever

 Refrain from sexual activity if getting health study or full body.

Day of Exam:

 Please wear underwear for your visit..

 Do not use creams, lotions, cosmetics, ointments, deodorant, antiperspirants, powders or any other skin product

 Please bring a hair tie to remove hair from your forehead and back of neck

 Remove all piercings and jewelry prior to exam, unless unable to.

4 Hours Prior:

 Avoid hot showers or shaving

 Avoid physical therapy or exercise

 No coffee, tea, soda, or other beverages containing caffeine. No alcoholic beverages.

 Do not smoke cigarettes or use any product which contains nicotine

 Women- do not wear a bra for the 4 hours leading up to the exam

2 Hours Before the Exam:

 Avoid hot or cold liquids (Room Temperature water is ok if you need it.)

 Avoid eating or chewing gum

 Avoid using a cell phone (Holding it up to your head or face)

Prior to and During Exam:

 Please inform us if you have a hot flash during the session

 Try to relax prior to and during the exam. Stress will affect your exam.


First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!