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Mammogram Anxiety Visit Card

A simple visit card for mammogram anxiety. Add comfort questions, support notes, contact choices, and after-visit notes.

Mammogram anxiety can be hard to say.

You can bring a short card.

You can read it. You can hand it over. You can keep it for yourself.

This card does not promise a certain care style. It does not explain procedure steps. It does not give medical advice.

Ask the center what will happen.

My visit card

Copy this into a note or print it.

<! third grade copy ignore next line text Mammogram visit card

My name:

Today I feel:

What I want the imaging team to know:

What helps me:

What makes it harder:

Questions I want to ask:

Support person or contact:

Privacy note:

After visit note:

Keep it short if that feels safer.

Name the anxiety

Use any words that fit.

I feel nervous. I feel scared. I may freeze. I may need a pause. I may need plain words. I may need choices repeated. I may need a support person. I may need notes written down.

You do not have to explain why.

Add only what you want the care team to know.

Comfort and consent questions

Pick the questions that fit.

Can you explain each choice in plain words? Can you tell me before you do anything? Can I ask for a pause? Can I stop the visit if I need to? Can I keep a support person nearby? Can I ask who will be in the room? Can I ask what will go in my chart? Can I ask what will show in the portal? Can I ask how results will be sent?

This card helps you ask.

It cannot promise how the facility will answer.

Support person and contact choices

Write what you prefer.

Prompt Your note Support person name Can they come with me? yes / no / ask first Can they get a call or text? yes / no / ask first Best contact method for me Contact method to avoid Portal messages okay? yes / no / ask first Voicemail okay? yes / no / ask first

Ask the facility what its rules allow.

Result contact questions

Breast imaging results can show up in many places.

Ask:

Where will results appear? Who will send the result? What contact method will be used? Will the message name the test? Will the portal show a preview? Who can see portal messages? Can I get a copy of the report?

ACR says patients get a plain mammogram summary.

Ask where your summary will appear.

Privacy light notes

You can keep a small note without writing everything.

Instead of Try Full story in an app note "Breast imaging visit." Full portal screenshot "Result will be in portal." Full support person details "Ask before calling anyone." Full past history "Private context. Ask me first." Full after visit summary "Visit done. Check portal if needed."

Keep facts the care team needs.

The goal is fewer extra copies.

After visit notes

Fill this out before you forget.

Question Your note What happened today? What did I agree to? What questions were answered? What question is still open? Where will results appear? Who can see the portal result? Who should contact me? What do I want to remember next time?

Do not use this card to choose care.

Use it only to keep notes from the visit.

Result privacy reminder

Mammogram results may show in portals.

They may also show in letters, PDFs, claims, and alerts.

Check where results may appear before you share.

For result records, use the breast imaging result privacy checklist.

You can also use the lab results checklist.

Use the patient portal checklist too.

For visit notes, use the Floriva appointment guide.

You can also use the doctor notes template.

For less data, read the period tracker data guide.

For result wording notes, use the mammogram result question list, abnormal mammogram result notes, breast ultrasound result questions, or breast biopsy result notes.