These Forms are Required for Breast Scans

Pt. prep. sheet – Breast Appointment

Patient Intake Form

Review of Systems

Upper Body Questionnaire

Breast Questionnaire

HIPAA

Extended Breast Questionnaire – only if you had breast cancer or breast surgery

Request For Alternative Cummunications

Home Office:
 

Essence of Pure Living
927 Miller Picking Rd
Davidsville, PA, 15928
Service Offerings: All Therapies and CARE Intensives

 

Remote Offices:
 

Toftrees Family Medicine
811 Cricklewood Ave.
State College, PA, 16803
Service Offerings: All Therapies

Live Well Adjusted
292 Main St.
Turbotville, PA 17772
Service Offerings: Thermography Only

Live Well Chiropractic
1634 Quaker Valley Rd.
New Paris, Pa 15554
Service Offerings: Thermography Only

Brouse Family Chiropractic
948 W. High St.
Ebensburg, PA 15931
Service Offerings: Thermography Only

Fresh Start Chiropractic
565 McElhattan Dr.
Lock Haven, PA 17745
Service Offerings: Thermography Only

Tranquil Beginnings
565 Pine Glen Rd.
Lewistown, PA 17044
Service Offerings: Thermography Only

Health by Choice
1721 Lafayette Road
New Enterprise, PA 16664
Service Offerings: Thermography Only

 

Out of State Offices:


Sherry's Spa
9526 Pine Knob Rd.
Clarkston, MI 48348
Service Offerings:  Specialized Services and CARE  Intensives

Wellness Day at Dorota's
318 Noroton Ave.
Darien, CT 06820
Service Offerings:  Specialized Services and CARE  Intensives

"Essence of Pure Living, LLC., Wholistic Thermography, and Equine Thermography exist to help you learn, research and make good choices for your wellness. We are not attempting to diagnose, prescribe, treat any medical condition you have. Information included on this site is not intended to diagnose, prescribe, prevent, treat or cure any issue, illness, disease or condition you have. "


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