Please note that this form is an appointment request only. To schedule your mammogram directly with our team, please call 860.291.6569
Once submitted, this form will be sent to our scheduling department and a member of our team will contact you to schedule your appointment.
Please select your preferred date, time and location and it will be accomodated based on availability.
Please select your preferred time and up to two (optional) alternate times in case your preference is not available.
* Note that ALL fields are required unless otherwise noted.