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Monday-Thursday 8:00AM-4:00PMFri, Sat, Sun - CLOSEDPrimary Care (904) 513-3240Pain Management (904) 206-71322624 Atlantic BlvdJacksonville, FL 32207

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Mammogram Appointment

This form is for NON-URGENT APPOINTMENTS ONLY.

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

Name(Required)

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Date of Birth(Required)

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Race

American Indian / Alaskan Native

Asian

Black / African American

Hispanic / Latino

Native Hawaiian or Other Pacific Islander

White / Caucasian

Two or more races

Language Spoken(Required)

Do you have breast implants?(Required)

Yes

No

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

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Primary Care: (904) 513-3240
Pain Management: (904) 206-7132

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If you need medical paperwork completed by a doctor, Emed is here for you. Below you can see our fee schedule based on what kind of documentation you need.

Administrative Paperwork Fees

Disabled Parking Permit …. Starts at $20.00
Physician Letter / Letter of Medical Necessity / Transportation .… Starts at $30.00
FMLA …. Starts at $70.00
Social Security / Disability Forms …. Starts at $100.00
Legal Documentation …. Requires a Quote
X-Ray CD …. Starts at $25.00
Medical Records …. $1.00 per page for the first 25 pages and $0.25 per page after that

Please allow 4 business days for the paperwork to be completed once payment is received

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Emed is now offering Telemedicine visits. To obtain an easy Telemedicine visit please answer the questions below and complete the “online telemedicine consent form”. Once done we will call you as soon as we can for the visit. Please note that we only do telemedicine visits Monday through Thursday. Requests received over the weekend will be called on Monday.

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