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NP Thermocheck Protocols and Preparation

  • It is very important that you follow these simple instructions carefully to ensure that your thermographic examination is accurate. If you cannot comply with any of the protocols listed below, please call the office prior to your appointment to discuss the matter and receive further instructions.

    1. You should not be sunburned or have fever at the time of your examination. Avoid sunbathing or sunbeds for 5 days prior to your scan.
    2. You should avoid chiropractic care, physical therapy, massage therapy, acupuncture, analgesic creams or balms, magnets or poultices for 24 hours prior to your examination. Avoid any physical stimulation of breasts for 24 hours before your scan.
    3. Do not shave your underarms within 24 hours prior to your examination. (if you wax your underarms, please avoid waxing for 7 days before your scan)
    4. Male patients must shave their chest 24-48 hours prior to the scan.
    5. If possible, avoid anti-inflammatory drugs until after your scan. If you are taking Beta- blockers, and are having a breast scan, if possible, hold off on the day until after your scan (a morning appointment may be more suitable for you if this is the case).
    6. Do not smoke cigarettes, chew tobacco or use any products which contain nicotine on the day of your examination unless ordered by your doctor
    7. Do not use creams, lotions, deodorants, talcum powder or other skin products on the day of your scan. (your underarm and breast areas)
    8. You should not drink coffee, tea, soda or other beverages containing caffeine (includes chocolate) for 4 hours prior to your exam. Please note eating is allowed.
    9. Do not perform any rigorous exercise program for at least 4 hours prior to your
    10. Do not bathe or shower in HOT water for at least 4 hours prior to your
    11. Do not wear a bra for at least 4 hours prior to your examination. Please note this includes sports bras or any breast support compressing the breasts.

    We do not recommend breast thermography if:

    • you had a mastectomy. (this includes single-sided mastectomy)
    • you have had a breast lumpectomy within 3 months of the procedure.
    • you have had a breast reduction/enlargement within 3 months of the procedure.
    • you have had a breast biopsy (including needle biopsies) within 3 months of the procedure.
    • you have had radiotherapy in the last 6 months of the procedure.
    • you are breast feeding or pregnant. We advise breast thermography 6 months after stopping breast feeding.

    I certify that I have complied with the above protocols and preparation instructions. If I have accidentally violated one of the above protocols that leads to cancellation of my scan, I understand that a missed appointment fee (50%) will be applied.

  • Please be advised that only the person that the form is referring to can fill out this form.
  • I confirm this form has been filled out by me
  • BREAST HEALTH QUESTIONNAIRE

  • History of breast cancer:
  • MEDICAL AND DRUG HISTORY

  • Please mark the area of the breast/s if affected by any of the following (use the letter to indicate):
    A: Mass    B: Thickening    C: Discharge    D: Nipple Change   E: Skin change    F: Pain    G: Burning    H: Tender    I: Dull ache   
    J: Sharp pain    K: Biopsy site    L: Itching    M: Scar   N: Lump
  • MEDICAL, SURGICAL AND DRUG HISTORY

  • CONSENT FORM FOR THERMAL SCREENING


    Infrared Imaging or Thermography is a non-contact, non-invasive test that helps reveal specific physiological patterns of your body. It is not a stand-alone or diagnostic test and it does not replace any recommendation given to you by your General Practitioner, Consultant or other healthcare provider for other forms of breast screening (e.g. mammograms). This information provided by your Thermogram is combined with your history, to enable your health care provider to plan an approach to your care.

    A licensed medical practitioner is the only qualified person able to formulate your diagnosis. He or she must combine the thermographic studies with your additional clinical and testing information to determine your condition or diagnosis. Thermograms provide evidence of thermal asymmetries that may be present. An asymmetry may be indicative of a vascular, muscular, inflammatory or other physiological problem.

    If food supplements are recommended by your physician, I consent to the self-administration of oral supplements and authorise that these will be prescribed by the physicians at The Natural Doctor®. I acknowledge that there are no guarantees or assurances made with respect to the benefits breast health therapy prescribed for me. I understand that I will be in charge of administering any prescribed supplements. I will confirm and comply with the recommended doses and methods of administration.

    I understand that further testing can be recommended. I agree to comply with requests for further testing (where this is necessary) to assure proper monitoring of my breast health. I agree to report to the physicians any adverse reaction or problems that might be related to my therapy. I understand that there may be possible risks and complications if I do not comply with the recommended dosage.

    I have been informed that insurance companies do not pay for this type of therapy at The Natural Doctor®. I therefore agree to pay for all the services including breast thermography, laboratory and pharmacy and supplementation charges myself, with the understanding that it is unlikely that I will be reimbursed by my insurance company.

    I have read the above information and I understand that I am not receiving a diagnosis of any condition based solely on my thermogram. I understand that a thermogram is non-invasive and is reading the thermal patterns on the surface of my body. From this information a qualified practitioner will interpret any thermal abnormality displayed. I have had all the information given to me about my scanning and that I fully understand the above and hereby request and consent to the procedures offered at The Natural Doctor®.

    I understand that if I require a chaperone, I will inform the team at The Natural Doctor®.



    I confirm the medical history information supplied is, to the best of my knowledge, true and complete


  • RECORD RELEASE

    I
  • authorise this clinic to release information regarding my scan/s, or to send copies of the thermal images to the following physician/s.
  • Please note that a copy of a valid photo ID is required in order to confirm your identity, your details are deleted after they have been verified

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Google Rating
4.8
The Natural Doctor
The Natural Doctor
4.8
Ros
Ros
16:57 08 Feb 20
I had some treatment for a breast condition in the clinic, people are very polite and nice including the doctors. I had to stop the treatment as It was not working but that's fair enough as no everything works for everybody. I stop going to the clinic and nobody in the clinic contacted me to find out what was going on, what happened with me. That showsed lack of care and I was disappointed about that.
Alison Kittle
Alison Kittle
14:33 14 Aug 19
Been visiting this clinic for nearly 10 years. It reassures me about my breast health and if I raise any concerns they are always answered well. Staff are professional but friendly. Dr Eccles knows his field. Will keep returning for my check ups. Peace of mind is worth so much.
maria
maria
13:27 16 Jul 19
For several years I have been seeing Dc Eccles for general l wellbeing. After I started seeing him, I felt much better. Excellent Doctor with very good supplements and product. I highly recommend Dr Eccles and his prescription.
Anwen Pragnell
Anwen Pragnell
14:50 20 Jun 19
A recent breast health scare in my 30's lead me to seek a less invasive option to check breast health. The Thermocheck scan, detailed report and Skype consultation with Dr Eccles was very professional and reassuring. I now feel more informed and supported in preparation for my hospital appointment. I highly recommend Dr Eccles and his team to provide an efficient, professional service and support your health naturally.
Arthur Moore
Arthur Moore
09:27 16 Jan 18
Thank you for giving me the opportunity to use your excellent product. Although it has only been 2 weeks, both myself and my wife have noticed, the hair growth has certainly become thicker, more of a covering. This is very encouraging, following many years of not really being bothered about my hair loss, now that I am noticing an improvement I am very excited at the prospects of once again having a full head of hair.
Victoria Harris
Victoria Harris
09:54 12 Aug 20
A very friendly but professional service. Experts in their field that go over and above to ensure you have the best service and experience.Highly recommend.
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