Individual request for no-cost screening mammogram (Solicitud individual de mamografía sin costo)
Texas Southern University Center Breast Cancer Screening and Prevention Center (TSU BCSPC) funded by the Cancer Prevention & Research Institute of Texas (CPRIT) provides no-cost breast cancer screening and diagnostic services, patient navigation/barrier reduction services, and evidence-based culturally appropriate breast cancer awareness and education services for African American and other ethnic minority women. Thank you for your interest in partnering with us to address breast cancer health disparity by providing this crucial services in our community.
What is your language preference? (¿Cuál es su preferencia de idioma?)
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English
Spanish (Español)
Other
What is your first name? (¿Cuál es tu primer nombre?)
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What is your last name? (¿Cual es tu apellido?)
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Phone Number (Número de teléfono)
Please enter a valid phone number.
What is your phone number? (¿Cuál es tu número de teléfono?)
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Zip code (código postal)
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County (Condado)
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Harris
Grimes
Matagorda
Walker
Wharton
Other
What is your email address? (¿Cuál es tu dirección de correo electrónico?)
Do you want to stay connected with us by joining our mailing list? (¿Quieres seguir conectado con nosotros uniéndote a nuestra lista de correo?)
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Yes (Si)
No
Do you want to stay connected with us by joining our mailing list? (¿Quieres seguir conectado con nosotros uniéndote a nuestra lista de correo?)
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Yes (Si)
No
Referred by (Referido por)
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Avenue 360
Bee Busy Wellness Center
Vecino Health Centers
El Centro De Corazon
Emancipation Park
MEHOP Bay City
MEHOP Wharton
Precinct 2
San Jose Clinic
Salud en mis Manos
Self
UT Health Women's Center-Wharton
Memorial Hermann
Other
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