[CORPORATE NAME] mammogram screening event

[event date]

[event address]



Screening mammograms are recommended for asymptomatic women 40+ years. However, most insurances cover one baseline screening mammogram for women 35-40 years.

Women with pain or symptoms of the breast should need to obtain a referral from their primary care provider to for a diagnostic mammogram. 

Women who are pregnant or breastfeeding should consult with their physician.

Getting your mammogram

Please fill out the appointment form below to schedule your mammogram. Our staff will contact you within 2 business days to confirm your appointment time.  Prior to your appointment, please prepare the following:

  • Wear a two piece outfit on date of exam

  • Bring a valid photo ID and insurance card

  • If you have had any prior mammograms at another facility, please bring the CD and report with you for comparison purposes

  • Download the patient paperwork to fill out prior to your appointment

PRIVACY: This is a secure site, all information remains confidential, federal (HIPAA) and state privacy law compliant AND will not be shared for any other purposes other than intended e.g. breast cancer screening as requested.

Appointment Form

Name *
Phone *
Where can we reach you to verify appointment / insurance information?
See dates available below
Your exam should take an average of 15 minutes. Please select a preferred start time. If your preferred time is not available, our office staff will call you to offer alternate times: **Appointment times will not be available between 11:30 AM - 12:00 as our staff will be on a lunch break. Thank you for your understanding.
Mammography Information
Are you a female over 40? *
Screening Mammograms are typically covered by Insurance if you are over 40 years.
Has it been at least one year since your last mammogram? *
Do you have breast implants? *
Our staff will need your photo ID and insurance card on the day of the event. If you are self-pay, please bring a Credit Card with you.
If none, write n/a