Mammogram Appointment Request Form

Patient information




If you would prefer confirmation of your appointment by email, please provide your email address.

* Do you have breast implants?

* Required fields



Hours of Operation

Monday/Wednesday 8:00 a.m to 4:30 p.m.
Tuesday/Thursday 7:30 a.m to 8:00 p.m
Friday 8:00 a.m to 4:00 p.m.
Saturday 8:00 a.m to 12:00 p.m. (2x/month)

Women's Center for Wellness

Department of Rockville General Hospital
2600 Tamarack Avenue, Suite 100, South Windsor, CT 06074
Tel: 860.533.4646 Fax: 877.869.9168


Preferred Appointment

1st
Choice

2nd
Choice

3rd
Choice



We will make every effort to accommodate your request. All appointment confirmations will be made by telephone or email within three (3) business days of request.

Please note that most insurance carriers will cover the cost of a screening mammogram if performed one (1) year and one (1) day after your last mammogram. If you have any questions about your insurance coverage, please feel free to contact our office.

This request form is for annual screening mammogram appointments only. If you have a breast concern, please contact your healthcare provider directly.



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