Colorado Thermography at The Thermogram Center: Breast, Body & Pain Imaging

The Thermogram Center provides imaging services by appointment at its imaging locations*. Scheduling is available in Boulder on some Fridays and Saturdays, Fort Collins on some Saturdays, Centennial on some Thursdays, Lakewood on some Tuesdays, and Gunnison and Steamboat Springs. Please call 303-664-1139 or toll free, at 866-492-2174 to identify the day, time, and location most convenient for you.

* Imaging locations are provided for a fee by independently operated health provider offices with no connection to The Thermogram Center, Inc. Each location provides facilities and space without service supervision, client involvement, or medical liability.

Appointment Documentation:

Prior to your appointment, you will be asked to review and/or complete several documents. Please print the requested forms so that you can review and complete them in the convenience of your home and prior to your office visit. Just bring the completed forms with you to your appointment. If you have any difficulties with printing from home, just let us know and we can assist you or provide the documents by fax. (Note: the documents are .pdf files. Click the browser back button to return here.)

PLEASE USE BLACK INK, PRESS HARD, AND WRITE LEGIBLY

WHEN COMPLETING THESE FORMS !!

● Dear Prospective Client (1 page)	Click to View/Print In Adobe Acrobat
● Insurance Coverage (1 page)	Click to View/Print In Adobe Acrobat
● Pre-Appointment Instruction Sheet (1 page)	Click to View/Print In Adobe Acrobat
● Health History Forms	CHOOSE ONLY THOSE THAT APPLY
- Breast Series (1 page)	Click to View/Print In Adobe Acrobat
- Abdomen/Back/Face Series (2 pages)	Click to View/Print in Adobe
- Other Series (3 pages) (Upper, Lower, or Full Body Series)	Click to View/Print In Adobe Acrobat
● Consent Form (1 page)	Click to View/Print In Adobe Acrobat
● Disclosure Statement (1 page)	Click to View/Print In Adobe Acrobat
● Imaging Locations/Maps (1 page)	Click to View/Print In Adobe Acrobat

The Thermogram Center is not a treatment or diagnosing center. Please consult with a qualified healthcare practitioner when seeking medical advice.