Wake Radiology now offers 3D mammography

Wake Radiology now offers 3D mammography at our North Hills Breast Center in Raleigh. Learn more

Schedule a screening mammogram

It’s easy to request an appointment for your screening mammogram at Wake Radiology. Simply fill out the information below. Learn more about screening mammograms and insurance

Once your appointment request is submitted, a member of our Scheduling team will contact you within 48 hours to set up your appointment at the specified date, time and location. If you contacted us on a weekend or holiday, please allow one additional business day. Email from Wake Radiology can be trapped by email filters. Please check your junk mail folder or adjust your span filters to allow mail from <wakerad.com>.

Do I Qualify for a Screening Mammogram?

You DO NOT qualify for a screening mammogram if you've had breast cancer or if you are experiencing any of the following:
• Unilateral new pain
• New discharge
• Lump(s), mass, density
• New nipple inversion
• Short term follow-up or any follow-up suggested by radiologist

 I qualify for a screening mammogram.

General Information

Who is your referring doctor?

Referring Doctor First Name

*Referring Doctor Last Name

*Practice Name

If you don't have a doctor, click here

Do you have breast implants?  Yes No

Appointment Information

Have you had a mammogram before?  Yes No

If yes, where?

*Have you been to Wake Radiology before?  Yes No

What is the preferred day of the week for your exam? (Not all locations offer evenings or Saturday appointments.)
 Monday Tuesday Wednesday Thursday Friday Saturday

What is the preferred time for your appointment?
 Morning Lunch Afternoon Early Evening

What is your preferred location? (3D mammography is currently offered only at our North Hills Breast Center.)

Patient Information

*First Name

Middle Name

*Last Name

*Date of Birth

Would you like an email confirmation of this sreening?
(For request confirmation use only. We will contact you via phone to schedule your appointment.)

Your Email

*Best Phone Number

Alternate Phone Number

Insurance Information

*Will you be using insurance?  Yes No

Primary Insurance

 I am requesting an appointment for a screening mammogram and understand that I will receive a confirmation of this request at the email address that is listed above. If I have not supplied an email address or if I don’t receive a reply, I understand that I can call WR Express Scheduling at 919-232-4700 and request an appointment. I verify that I am an established patient with the referring doctor that I have listed in this request.

Please type the letters you see to the right of the box below: