Pink Campaigns

 

  

 

 

 

Keep Project Mammograms FREE

Donate Today!

 

 

 

 

Free Breast Cancer Screening

  

Free Breast Cancer ScreeningMany women at risk for breast cancer in this country are under insured or do not have any health insurance at all.

 

At PINK CAMPAIGNS your health and well being is priority one. SOLUTIONS FOR THE CURE through early detection, prevention and awareness. Now you have no excuse for not having a mammogram every year.

 

The solution for the cure is; beating it before it has a chance to start.

At Pink Campaigns we offer Project Free Mammograms to all as part of early detection.

 

 

 Stay informed of dates and times for the Mobile Screening Unit With our monthly Newsletter.

 

   
Name:
Age
Daytime Phone: ( )
Email:
Address:
City:
State:
County:
ZIP: -
Sex: Female Male
Have you noticed any new changes in your breast recently which are not related to monthly discomfort? Yes No
In which breast? Left Right Both
Which of the following apply?
Lump
 		 Dimpling
Redness
 		 Change in Shape
Rash
 		 Bulging
Unusual Pain
 		 Inverted Nipples
Persistent Nipple Discharge
How long ago was your last breast screening? What type of screening? (years)

 
Is there a history of breast cancer in your family?
If so, what is the relation?		 Yes No Don't Know Relation
Who's side of the family had this history of breast cancer?
At what age?		 Mother's Father's Age (if known)
How did you hear about Pink Campaigns Project Free Mammogram?
Would you agree to share your experience with Pink Campaigns? Yes   No
Please include any additional comments, questions or needs you may have.

 
The next page we give the option for our Newsletter.

 		  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 

 
 


 

 
 
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AmerinRio is a registered U.S. 501(c)(3) charitable organization.

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