Request a Mammogram or Imaging Appointment

Please complete the form below to request an appointment at a MemorialCare location near you. After completing the form, a MemorialCare representative will call you within one business day to finalize scheduling details and answer any questions you may have.

Estimating Your Costs Prior to Service
We want you to have the best possible experience with MemorialCare. Part of that is understanding your health benefits and the estimated out-of-pocket expenses you are responsible for prior to receiving services. Because health care benefits vary, we encourage you to contact your health plan to estimate your cost. Or if you are a cash paying patient, we can help you estimate your payment, or check our Cash Pricing Tool. Please contact Patient Financial Services for further assistance.

No appointments are necessary for Diagnostic Radiology (X-ray). If you have a prescription for Diagnostic Radiology (X-ray) please visit one of our locations to be seen as a walk-in.

Request Your Appointment

Request an Appointment for*

For a Digital Mammogram select a MemorialCare Breast Center location

For a Breast MRI select a MemorialCare Breast Center location

For a Breast Ultrasound select a MemorialCare Breast Center location

For a Bone Density Scan select a MemorialCare Imaging Center location

For a CT Scan select a MemorialCare Imaging Center location

For an Early Lung Cancer Screening CT Scan select a location

For an MRI select a MemorialCare Imaging Center location

For a Nuclear Medicine exam select a MemorialCare Imaging Center location

For a PET/CT Scan select a MemorialCare Imaging Center location

For an Ultrasound select a MemorialCare Imaging Center location

Preferred Appointment Date & Time

Select a preferred weekday (Monday to Friday) and appointment time.

Month*

Day*

Year*

Preferred Time*

Name

First

Last

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Cell or Home Phone*

Work Phone

Email Address*

Anything Else?

Comments

Math question* 16 + 0 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

Patients & Visitors

Medical Professionals and Staff

Request a Mammogram or Imaging Appointment

Request Your Appointment