Screening Mammogram

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Patient Information

Clinical Information (please complete all questions)

(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.)
(3D mammography is beneficial for all women - particularly those with dense breasts or having their first mammogram.)

If yes, please choose one of the following:

Preferred Locations

All our locations, including those served by our Mobile Breast Center, offer 3D mammography, the latest technology in breast cancer detection. 3D is now covered by most insurance; we encourage you to contact your insurance provider with any coverage questions.

Mobile Breast Centers:

Preferred Date and Time

First Available

Use this section to select a specific day of the week and time of day preference:

Preferred Day of the Week:

Preferred Time of Day :

* 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)