If you did not have your prior mammogram(s) at The Westerly Hospital, please:

• Print out the Consent for Release of Mammogram Records form
• Fill in the required information
• Sign and date the consent form
• Mail or fax the form to your prior radiology office or bring the consent form to the Westerly Hospital Diagnostic Imaging Center two weeks prior to your mammogram appointment, and we will send the request for you.