• Women of Color: Strengthened by Action

    Women of Color: Strengthened by Action

    Mammography Form

  • Congratulations! You’ve committed to taking charge of your breast health by getting screened for breast cancer. Please answer honestly to the best of your ability.

  • Which of the following best describes you?*
  • Have you had a mammogram exam this year (2022)?*
  • Are you a Broward County resident?*
  • Do you have health insurance? *

  • Thank you for taking the time to fill out our survey! A representative from Florida Mobile Mammography will be in contact with you to schedule your appointment time. Singular appointments will be made in 15mins intervals to allow for social distancing

  • Should be Empty: