About you
We will use this information to remind you when it’s time for your next appointment or check-up. Find out if you need to do anything for Breast Cancer screening next.
First Name
*
Last Name
*
Email
*
example@example.com
Mobile Phone Number
We will only ever SMS you reminders.
Postcode
*
Gender assigned at birth
*
Male
Female
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It takes less than 1 minute, and could save your life!
Have you ever completed a mammogram (also called a mammographic screening or breast screening)?
*
Yes
No
When did you have your last mammogram?
-
Day
-
Month
Year
If you can't remember, an approximate date is fine!
Date of Birth
*
-
Day
-
Month
Year
Screening is available to those within the age group.
Todays date
-
Day
-
Month
Year
Age
Last Mammogram Test
Years since last test - Not used anymore
Last Mammogram Test - Months
Months since last test
Last Screening Score
If 1000, they are due for screening. They are of age and haven't done one for 2 years, or have never done one.
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Are you experiencing any of the following symptoms?
Persistent new lump or lumpiness, especially involving only one breast
*
Yes
No
Change in the size or shape of a breast
*
Yes
No
Change to a nipple, such as crusting, ulceration, redness or inversion
*
Yes
No
Nipple discharge that occurs without manual expression
*
Yes
No
Change in the skin of a breast such as redness, thickening or dimpling
*
Yes
No
Axillary mass(es)
*
Yes
No
Unusual breast pain that does not go away
*
Yes
No
Score
Due for Screening: 1000
Immediate action required: 10-100, 10010+
No action: 0
recommendationWp
dueDate
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Year
-
Month
Day
Date
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