Skip to Content

Mammogram Pre-Registration

For your convenience, Palos Health now offers online pre-registration for Mammography services. Simply complete the 10-20 minute Online Pre-Registration form at least three (3) business days prior to your scheduled appointment. Check-in with our registration staff on the date of your scheduled service to complete the registration process. 

* Denotes required fields

Patient Information

* Do you speak and understand English?
* Are you sensitive/allergic to latex?

Employment Information

Spouse/Primary Emergency Contact Information