Georgia Mammo Release Form

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WIS Mammo Release (Georgia)

PLEASE NOTE: The data you enter below is fully secure, encrypted at rest using 256-bit AES encryption, and accessed over HTTPS (SSL) 100% of the time for HIPAA compliance. If you need to save your progress, click “Save” at the bottom and return within 7 days using the link that is emailed to you.

COVID-19 Update: The health and well being of our patients at Women’s Imaging Specialists is always a priority. Under normal circumstances, our offices undergo rigorous cleaning throughout the day. Since learning of COVID-19, we are taking extra precautions to ensure the safety of our patients and staff. Additionally, none of our locations are located in any hospital or share any corridors or parking areas with a hospital system.

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COVID-19 Update: The health and well being of our patients at Women’s Imaging Specialists is always a priority. Since learning of COVID-19, we are taking extra precautions to ensure the safety of our patients and staff.

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