Screening Mammogram Appointment Request SSL

To request an appointment for a screening (routine) mammogram, please complete the secure form below and select the send appointment request button. A representative will contact you within one business day to book a convenient appointment time.

By submitting this request, you are authorizing Baptist to contact you using the methods you provided below.

If you are requesting a diagnostic mammogram to investigate inconclusive or suspicious results from a screening mammogram, please contact us by phone at 904.202.2222.

• Patient Information

  • Full Name*

  • E-Mail Address*

  • Primary Phone Number*Type - Cell Phone Home Phone Work Phone

  • Gender* - Male Female

  • Do you have a primary care doctor? Yes No