#My1stMammo Registration Form 2026

#My1stMammo

Registration closes on 31 October 2026
This screening is only free for females aged:
- 40 years and above (based on birth date)
- Valid blue/orange CHAS card
- Valid Public Assistance (PA) / ComCare Long-Term Assistance
- Have not undergone a mammogram in the last 12 months for women aged 40-49, and 24 months for women aged 50 and above
- Have not received breast implants
- Is not undergoing breast cancer treatment
- Is not pregnant
I understand that this screening is only eligible for females who meet the specified criteria, which may include age, medical history, and other relevant factors. I also understand that the clinician has the right to reject my registration should I fail to meet the eligibility criteria.

utm_campaign
utm_source
NRIC Name

Given NameFamily/SurName
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Gender
NRIC
last 3 digits + alpha
Email
example@example.com
Contact Number
I have a
CHAS/Public Assistance Card

Please upload a photo/screenshot image of your blue/orange CHAS card or Public Assistance card (front) for verification.
Cancelof
This is my first mammogram.
My last mammogram was in
Choice of Clinic
I understand that my participation in the '#My1stMammo' involves sharing my screening results with 365CPS to monitor the overall success of the campaign and to provide me with relevant health information and resources based on my results (if applicable).

#My1stMammo