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Mobile Mammography Appointment Registration

We are pleased to bring this important life-saving service to your workplace, if your organization is confirmed for a visit from the Healthy U Express, please complete the following registration form.

Please keep in mind, mobile mammography is not for everyone. You may need a different type of mammogram and exam if you have had a previous personal experience with breast cancer, are experiencing certain symptoms or have had other problems such as:

  • Large nodes under your arm
  • Bloody discharge from breast(s)
  • Palpable abnormality or a lump you can feel
  • Skin thickening or retraction on clinical examination
  • Mass or calcifications detected from a previous mammogram

Call 358-7020 to discuss your personal situation with a patient navigator and they can help you schedule an appointment, or call your personal physician.

Before starting this form, make sure you have all the required documentation for fields like insurance information (especially if you are dependent on another insurance plan), history of previous breast procedures and mammograms as well as contact information of the facility performing the screening or procedure.

Information provided is subject to HIPAA Privacy standards.

All fields are required

>> Begin Appointment Registration Form