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(please complete all questions)
*Do you have any new breast lumps or problems with your breast?
*Do you have breast implants?
*Does anything hinder your mobility (ie. crutches, cast, wheelchair)?
*Have you had a mammogram at a facility other than Charlotte Radiology?
(If yes, please bring to mammogram apppointment or bring the name, phone and fax number of prior facility and we will attempt to obtain prior mammograms.)
*Are you interested in adding 3D/tomosynthesis to your mammogram?
(3D mammography is beneficial for all women - particularly those with dense breasts or having their first mammogram.)
All of our locations, including those served by our Mobile Breast Center, offer digital mammography, the latest technology in breast cancer detection. Exams are performed by specialized technologists and read by sub-specialized physicians in the area of mammography.
Preferred Date and Time
Use this section to select a specific day of the week and time of day preference:
Preferred Day of the Week:
Early morning (7:30am-9am)
Late morning (9am-11am)
Early afternoon (1pm-3pm)
Late afternoon (3pm-4:30pm)
What is more important to you when scheduling your appointment?
* Saturday appointments vary by facility. If you choose a Saturday appointment, the location and time requested may vary.
What prompted you to schedule your mammogram? (check all that apply)