Thank you for choosing Main Line Health.

Please complete our mammogram appointment request form below and a member of our staff will schedule your appointment and confirm via email within the next business day.

If you prefer to make your mammogram appointment by phone, you can call us at 484.580.1800 to speak directly with a representative. If making an appointment by phone, you do not need to fill out the form below.

Asterisk(*) denotes a required field.


Patient Information

(MM/DD/YYYY)

Contact information
Ordering physician
Appointment information
Appointment location and time

Please note that Saturday hours are only offered at: Bryn Mawr Hospital Outpatient Imaging Center - Bryn Mawr, Lankenau Medical Center, Paoli Hospital, Main Line Health Center - Broomall and Riddle Hospital.

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