Mammogram Appointment Request

Patient & Visitor Information

Mammogram Appointment


Please review the following requirements to determine if you are eligible for a mammogram screening. Then complete the form below. Once submitted, our office will contact you within one business day to schedule your appointment.

  • You must be at least 40 years old. If you are age 30-39 and have a mother or sister who was diagnosed with breast cancer before age 40, then our “10 year rule” applies. For example, with a first degree relative diagnosed at age 42, your eligibility begins at 32.
  • One year since your last mammogram.
  • Not pregnant.
  • No breast issues (such as lump or discharge from nipple area).
  • Can climb the unit stairs and stand for 10-15 minutes without assistance.
  • Has seen an OBGYN or primary care provider within the last year who is willing to accept screening results.

Important Notice: Mammograms are conducted by appointment only for January 19th, 2024 starting at 8:00am. Any unscheduled walk-ins will not be accepted. Appointment cutoff date is Friday, January 5th.

Mammogram Online Registration

MM slash DD slash YYYY
Do you have breast implants?(Required)
Marital Status
This field is for validation purposes and should be left unchanged.

We have decades of combined experience in primary care! Whether you have a cold or just need a checkup, we’re here for you!

Convenient communication, call or text.
Primary Care: (904) 513-3240
Pain Management: (904) 206-7132

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