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• Holy Name in Haiti

In This Section

• Breast Center
• Benign Breast Conditions
• Contrast Enhanced Spectral Mammography
• 3D Mammography
• Breast Cancer
• Breast Surgery
• Breast Center Team
• Breast Surgery Team
• Bone Density Testing
• The New Breast Center

For More Information:

201-833-7100
Breast Center

info@holyname.org

Mon: 7:30 AM - 7:30 PM
Tue – Fri: 7:30 AM - 6:00 PM
Sat & Sun: 8:30 AM - 3:00 PM

Billing Questions Regarding:

Outpatient Hospital Billing:
201-833-3341

Physician Billing:
201-833-3099 (Tue-Fri)
855-602-9757 (Mon-Fri)
866-662-3146 (Mon-Fri)

For Images/Reports Copies:

To obtain your copies:
201-833-3193
Please allow 24 to 48 hours for availability

Patient Stories

• Laura Ayala
• Janet Capone
• Donna Dugan
• Ann M

This Place is Different.

Schedule a Mammogram

Has your physician ordered a mammogram with breast ultrasound and/or do you have any breast problems? * Yes       No

Please contact our schedulers at 201-833-7199 option 2 to schedule an appointment.

Patient Information

* Indicates required information

First Name: *	Last Name: *	Date of Birth: *  Month  January February March April May June July August September October November December  Day  1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  Year  1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Email Address: *	Day Time Phone (Mon-Fri): * - -	Preferred Contact Method: *  Email        Phone
Clinical Information * Indicates required information
Referring Physician: *	Insurance Plan Name: *
Have you had a breast imaging exam at another facility within the last 5 years? * (New patients should bring all previous breast imaging studies – film or disc – and reports) Yes       No
If so, where, when?
Comments or Questions:
Are you planning to schedule a bone density test? * Yes       No
Scheduling Preference Information
Please indicate your appointment date and time preferences:
First Preference Day:	First Preference Time Range: Select one 7:30 AM - 9:30 AM 9:30 AM - 11:30 AM 11:30 AM - 1:30 PM 1:30 PM - 3:30 PM 3:30 PM - 5:30 PM 5:30 PM - 6:30 PM
Second Preference Day:	Second Preference Time Range: Select one 7:30 AM - 9:30 AM 9:30 AM - 11:30 AM 11:30 AM - 1:30 PM 1:30 PM - 3:30 PM 3:30 PM - 5:30 PM 5:30 PM - 6:30 PM
Third Preference Day:	Third Preference Time Range: Select one 7:30 AM - 9:30 AM 9:30 AM - 11:30 AM 11:30 AM - 1:30 PM 1:30 PM - 3:30 PM 3:30 PM - 5:30 PM 5:30 PM - 6:30 PM
Please note: This online request form will not officially book your appointment at Holy Name Medical Center. You will receive an email notification or a phone call to confirm the actual date and time within 48 business hours from your request. Submit Request