Required Forms

In anticipation of your appointment, please complete the forms below.

Forms for your appointment

Please complete all forms and bring with you to your scheduled appointment. Your technician will review all forms with you prior to your exam and answer any questions that you may have.

Thermography Forms

New Patient Thermography Forms Return Patient Thermography Forms

Ultrasound Forms

Screening Ultrasound (Self-Referred) Diagnostic Ultrasound (Physician Referred) Obstetric Ultrasound (Physician Referred)

Preparing For your thermogram

VIEW INSTRUCTIONS

Preparing For your Ultrasound

VIEW INSTRUCTIONS
oblique thermogram of neck
thermography of neck and shoulders
anterior breast thermogram

Cancellation Policy

  • All scans require 48-hour notice
  • Late cancellations will be subject to up to 50% the cost of the service
  • No shows will be subject to up to 100% the cost of the service

Why We Enforce a Cancellation Policy

At Mend, we intentionally reserve longer appointment times so you feel heard, supported, and never rushed. Your visit is an experience, not a quick transaction. When appointments are canceled without proper notice, it leaves gaps that other patients may have needed and significantly impacts our small practice. Because of this, we ask that you honor the time you schedule and commit to your appointment.

 

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