Mammography Appointment

Please note: it may take our team a few days to call you to schedule your appointment. We appreciate your patience and congratulate you on taking control of your health. By providing your insurance information and recent mammogram location, we will be able to schedule you sooner.

If you have any questions regarding this form, please call 1-800-ROSWELL (1-800-767-9355).

Personal Information

About You

Contact Methods

Your Patient's Insurance Information Optional
Providing your insurance information will help us schedule your appointment faster.

Care Questions

At which location would you prefer your mammogram appointment? *

Previous Mammograms
Providing your information about your most recent mammogram will help us schedule your appointment faster.

Have you had a mammogram at Roswell Park before? *

Lung Health

Within the last 15 years (including the present) have you smoked cigarettes? *

Have you smoked the equivalent of 1 pack a day for 30 years (OR 2 packs a day for 15 years)? *

Roswell Park Comprehensive Cancer Center offers a lung cancer screening program.
Based on the information you provided, you may be eligible. A patient access representative will be in contact with you about scheduling this appointment, which includes a low-dose CT scan to screen your lungs for early lung cancer.