Mammogram Request

October is Breast Cancer Awareness Month
During breast cancer awareness month do something that makes you feel better about your health and schedule your annual screening mammogram. We understand mammograms aren’t always comfortable but we’ll do our best to make your experience a positive one and it could save your life. In celebration of your health and wellness during the month of October Jefferson Hospital offers Mammograms for $100 to those patients in our Community that do not have any form of insurance coverage. If you have insurance most companies allow one screening Mammogram per year.
Who should have a Mammogram?

The American Cancer Society recommends starting annual screening Mammograms if you wish to do so for ages 40 to 44. Women age 45-54 should get their annual screening mammogram every year. Women 55 and older should switch to Mammograms every 2 years or can continue yearly screenings. Screening should continue as long as a women are in good health and is expected to live 10 more years or longer. All women should be familiar with their own breast and should do breast self-exams regularly. They should know how their breast normally look and feel and report any changes to their Health care provider right away.  It is important to note, if you feel you are having a problem with your breasts, please contact your physician’s office to schedule an appointment to discuss your concerns.  Only annual screening mammograms can be performed without an order from your physician.

Early detection is always your best protection against Breast Cancer.

If you would like more information about your annual screening Mammogram or if you would like to set up an appointment for your screening Mammogram please fill out the information below and one of our Mammogram Technologist will contact you at the best available time for you.

Mammogram Request Form
Patient Name:*
Date of Birth:
Best Day & Time for a returned call:
Date of last mammogram
Any questions or concern: