Schedule a Screening Mammogram

You will be sent verification of your appointment via email address. Please verify it.

Please bring your mammogram films if not done at a STRIC facility.

Physician Name (First & Last)

Physician Address

Full Name (First and Last)*

Date of Birth

/ /

Phone Number

Mailing Address

City

State

Zip Code

E-Mail Address

Insurance

If other insurance please specify

Insurance Group Number

Insurance Policy Number

Do you have orders from your doctor?

Give us 2 dates you are available

First Choice
/ /

Second Choice
/ /

Weekday Appointment Options

I need a specific time of

Saturday Appointment Options

I need a specific time of

Please select a Screening Mammography Location

Do you have any new breast issues since your last screening mammogram (pain/discomfort, lumps, discharge etc.)?

Do you have breast implants?

Are you interested in adding 3D Digital Breast Tomosynthesis to your mammogram?

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Material contained within this website is for informational purposes only and is not intended as professional medical advice, diagnosis or treatment.