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        Thank you for using our online mamography scheduling program.

       Breast cancer is one of the the most common cancers in women. Breast cancer will affect on average one in eight women sometime in their lifetime. The stage at which breast cancer is detected influences a woman’s survival. If breast cancer is detected in its early stage, the five year survival rate is 97 percent or greater. Screening mammography, utilizing a digital mammography system, is the most effective technology for the early detection of breast cancer.

Step 1. Select the Center 

                                                        Royston Diagnostic Center

                                                        Athens Diagnostic Center

                                                        Coosa Diagnostic Center (Rome)   

STEP 2. DO YOU QUALIFY TO SCHEDULE YOUR SCREENING MAMMOGRAM ONLINE?  

               In order to qualify, you need to answer NO to all the following:

                 * Are you under the age of  ?

                 * Have you had a mammogram in the last year (365 days)?

                 * Are you experiencing any breast issues or problems (ex: lump, pain, discharge, etc…)?

                 * Are you pregnant or nursing?

                 * Is this a follow up exam from a previous study (ex: breast biopsy, abnormal mammogram, etc…)?

    If you’ve answered YES to any of the above questions, please call   to schedule your exam.

STEP 3. pATIENT INFORMATION 

    *please note that all fields below are required fields

First name:             Last name: 

Date of Birth:          Contact Phone number:  

Insurance Company:  

    * (If you don’t have insurance, our self pay price is $149 and that includes everything- the test and the reading.)

Referring Doctor:  

Do you have a written order from your doctor:   

      *(If you don’t have an order, that’s no problem.  We’ll talk to your doctor and facilitate getting it for you.)

Are you having any problems with your breasts:      

Do you have implants:     

Is this a follow up exam to a prior study (ex:  breast biopsy, abnormal mammogram, etc..)  

Have you had a prior mammogram:    

If so, Where was it done:     

Approx. Date:   

Preferred days/times (ex:  day or times that are better for you):

 

How would you like us to contact you with your appointment date and time:

Phone1:             Phone2:              

Or    Email  

                                                            

                                                                                                      

                                                  

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