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Online Scheduling for Screening Mammogram


Welcome to Online Scheduling. Please follow the quick and easy steps 1 thru 4.
If you have a medical emergency, please call 911.

STEP 1: Do I Qualify for a Screening Mammogram?
*
You DO NOT qualify for a screening mammogram if you have had any of the following:
  • Lump, nipple discharge or other change in your breast in last 3 months
  • Mastectomy, Breast Surgery or a Needle Biopsy in last 3 to 6 months
  • Breast Implants rupture or leakage
  • Or if this mammogram request is a six-month follow-up
  • Or if you are under the age of 40. Under 40 requires a doctor's referral.
If none of the above applies to you, please check the box and continue to STEP 2.
 I qualify for a screening mammogram. I will schedule my screening mammogram at least 366 days from my last exam for insurance claims.
If you answered yes to any of the questions above, you DO NOT qualify for
a screening mammogram. Please contact Central Scheduling at (310) 301-6800 to schedule your appointment.

STEP 2: UCLA Patient Information
* Last Name:
* First Name:
* Date of Birth:
* UCLA Medical Record Number:
* Phone Number:
* Primary Care Physician:
* Medical Plan:
* Email Address (optional)

Why we ask for your email?

STEP 3: Select Appointment Preference
* Preferred Location, Date, and Time:
For insurance claims, please schedule your screening mammogram at least 366 days from the last exam.

STEP 4:
If you need to reschedule or cancel after submitting this request, please contact Central Scheduling at (310) 301-6800.

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