Film Request Form

Please send your image request through our patient portal utilizing the secure message tab. If you are not already registered on the patient portal please create a new account. You may access the patient portal by clicking on the link below.

Click Here to Access the Patient Portal

We will confirm your request by phone or by email. On-line requests will be followed up within one business day of request receipt, Monday through Friday, 8:00 a.m. and 5:00 p.m. If you do not receive a response from us within 48 hours, or if you have any questions, please contact our office by phone at (203) 267-5800.

Important Items to Note

  • Allow 24 hours advance notice of desired image pick up.
  • When picking up your images or reports, you will need to present photo identification. If someone other than the patient is picking up the records, a signed, written authorization from the patient is required.
  • Mammogram films are loaned to you and should be returned as soon as possible.