Mastectomy Lymphedema Prevention Assessment Form

Managing lymphedema risk after mastectomy requires proactive monitoring and education. This Mastectomy Lymphedema Prevention Assessment Form provides healthcare providers with a structured telehealth solution to establish baseline measurements, prescribe preventive exercises, and educate patients on essential precautions—all through a secure, virtual consultation.

Designed for breast cancer survivors, oncology nurses, physical therapists, and lymphedema specialists, this form streamlines post-surgical follow-up by capturing arm circumference measurements, assessing risk factors, and delivering personalized care plans remotely. Whether you're conducting virtual check-ins or onboarding patients into a lymphedema prevention program, Paperform helps you deliver compassionate, organized care from anywhere.

Why healthcare providers choose Paperform for telehealth assessments:

Paperform's conditional logic ensures patients receive tailored guidance based on their surgery type, risk factors, and symptoms. You can embed instructional videos for proper measurement techniques, attach educational PDFs about compression garments, and use calculation fields to track changes over time. With secure data collection, HIPAA-friendly workflows (when configured appropriately), and integrations with your practice management software, Paperform becomes the hub for your virtual lymphedema prevention program.

Connect your form to Stepper to automate follow-up sequences—schedule measurement check-ins, send exercise reminders, trigger referrals to certified lymphedema therapists, or alert your care team when a patient reports concerning symptoms. You can also use Papersign to collect informed consent for telehealth services or treatment plans, keeping all documentation linked to the original assessment for seamless compliance.

Whether you're a breast health center, home health agency, or oncology practice expanding virtual care, this template helps you provide evidence-based lymphedema prevention that improves outcomes and empowers patients to take an active role in their recovery.