Fill out this form and our CALL CENTER will contact you to schedule your procedure

Need help making an appointment? Call 296-8888, Monday through Friday 8am thru 5:30pm."

First Name * 
Last Name * 
Date of Birth *  mm/dd/yyyy
Email Address * 
Address * 
Address 2 
City * 
State * 
Zip * 
County * 
Primary Phone *  () - Ext.
Alternate Phone  () - Ext.
Date * 

When would you like to receive a call back?

Our hours of operation are Monday through Friday 8:00 am to 5:00 pm

Time * 
What would you like to schedule * 

Please note that a prescription is required from your physician for scheduling Mammograms and DEXA Scans

Physician appointments cannot be scheduled online. Please contact your doctor's office to make an appointment.

Preferred Location * 
Palmetto Health Baptist 
Palmetto Health Baptist Easley 
Palmetto Health Baptist Mobile Mamography 
Palmetto Health Baptist Parkridge 
Palmetto Health Richland 
Reason for Appointment * 
Physician First Name 
Physician Last Name 
* Required