woodland hills | MAMMOGRAM SCREENING

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TUESDAY, OCTOBER 22ND

wEDNESDAY, OCTOBER 23RD

THURSDAY, OCTOBER 24TH

21281 BURBANK BLVD, WOODLAND HILLS, CA

*Appointments will not be available during Alinea staff lunch breaks. Lunch breaks will vary between events dates. Please check CNET for event details.

qualifications 

Screening mammograms are recommended for asymptomatic women 40+ years. If you are covered under HealthNet’s employer plan you can receive a baseline screening even if you are under age 40. A referral is not required by your doctor.

Women with pain or breast discomfort would need to obtain a referral from their primary care provider in order for a diagnostic mammogram.

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 the day of the exam

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

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

    • You can securely send completed forms back to Alinea. Please have them e-mail all forms to Marianita Ramirez at [email protected]

    • Please send documents by October 18th, any documents received after this date will have to be brought with you to your appointment

  • Please bring the following items with you to your appointment:

    • Employee badge

    • Photo ID

    • Insurance card (Alinea staff will only reference to confirm Physician details to help speed up the check-in process. The screening will come at no cost to the employee)

    • Complete pre-appointment paperwork (unless already submitted online).

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

PATIENT INFORMATION
Name *
Name
Date of Birth *
Date of Birth
Enter your date of birth in MM/DD/YYYY format
Phone # *
Phone #
Where can we reach you to verify appointment / insurance information?
Please select your desired appointment date below
Please select appointment time. If your requested time is already booked, our scheduler will offer you alternate time slots.
MAMMOGRAPHY INFORMATION
Are you a female over 40? *
Screening Mammograms are typically covered by Insurance if you are over 40 years. If you are under 40, we will have to verify with your insurance plan if you are covered for a mammogram exam. Please provide insurance information below for eligibility and verification purposes.
Has it been at least one year since your last mammogram? *
Do you have breast implants? *
Breast implants require additional screening time, and Alinea will have to make sure to schedule you appropriately.
INSURANCE / PAYMENT INFORMATION
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 Providing your member ID at the time of registration will help us verify your insurance and eligibility prior to your mammogram screening appointment.
If you marked "OTHER" in the insurance section, please input your insurance plan along with your member ID # here. Thank you.