Schedule a Test

Schedule a Test

Online Test and Screening Scheduling

Here you can schedule a test or screening at Little Company of Mary Hospital and Healthcare Centers. Complete the form below and indicate in the message what test or screening you would like to schedule. After submitting your form, you will receive a phone call confirming your appointment.  Some payers require additional information.

 

If you wish to schedule an emergency or urgent care visit, screening, mammogram, or ultrasound, please click the "Schedule ONLINE" button located on the top, right-hand side of this page.

 

Please download the forms below, fill them out, and bring them with you to your next appointment.

 

For Medicare Patients Only

Privacy Notice (English)*

Privacy Notice (Spanish)*

Financial Responsibility Form (English)

Financial Responsibility Form (Spanish)



 * To view LCM Notice of Privacy Notice Acknowledgement (English)

 * To view LCM Notice of Privacy Notice Acknowledgement (Spanish)

Required fields are marked with an asterisk *

First Name *
Last Name *
Address *
City *
State *
Zip *
Telephone *
Date Of Birth (mm/dd/yyyy) *
Email Address *
Type of Test *

Characters remaining:

Ordering Physician
Diagnosis
Facility Preferred
(not all tests are performed
at each facility)
Type of Insurance
Insurance ID Number
Insurance Group Number
Message *

Characters remaining:

I'd like to join the Little Company of Mary elist. *
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