An improved patient temperature exchange system and method is disclosed for use with one or more interconnectable patient contact pads. In one embodiment, the system includes a circulating pump for drawing fluid through the interconnected pad(s) under negative pressure, and for pumping the fluid through one of more heat exchange devices into a circulating reservoir. A make-up reservoir may be provided for gravity fluid flow into the circulating reservoir during the filling of the interconnectable pad(s) and for receiving fluid upon emptying of the interconnectable pad(s). During normal heating/cooling operations, the circulated fluid does not pass through the make-up reservoir, thereby yielding a highly responsive system. The make-up and circulatory reservoirs may be directly interconnected, with the make-up reservoir maintained at atmospheric pressure (e.g. via a non-spill vent). To reliably maintain the desired negative pressure in the interconnectable pad(s), the system may provide for fluid pressure sensing on the inlet side of the circulating pump. The sensed pressure may be utilized to control the speed of the circulating pump. The system may further provide for the positioning of pressure drop a componentry on the outlet side of the circulating pump, thereby further facilitating the maintenance of a desired negative pressure within the interconnected pad(s). A bypass fluid line may also be included to provide for fluid preconditioning prior to interconnection of and/or fluid flow through the pad(s). Multiple temperature sensors and an interface for an external patient temperature input may also be provided for enhanced fluid heating/cooling control.