Request a Screening (Annual) Mammogram Appointment

Complete the form below and click the SUBMIT button to send us an online appointment request.

**THIS FORM IS TO BE USED TO SCHEDULE SCREENING (ANNUAL) MAMMOGRAMS ONLY**

If you are attempting to schedule a Diagnostic Mammogram, please call our Central Scheduling Department at 609-394-6695 (Monday - Friday, 7:30 a.m. - 5:30 p.m.)

You will receive a call from one of our representatives within one business day to schedule your appointment. Appointments are scheduled based on availability, and our representatives will work with you to confirm a day and time that is convenient for your schedule.

**IMPORTANT** If you are attempting to schedule an appointment within 48 hours, please call our Central Scheduling Department at 609-394-6695 instead of using this form.

Name

Request Appointment Time

PLEASE NOTE- Your appointment will be confirmed when a Capital Health representative calls you to verify this. You will receive a call within 24 hours (or next business day if you are making your request on a weekend or holiday) to confirm your appointment.

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