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mammogram screening questionnaire

On June 24th from 11 am until 3pm Sentara Mammography bus will be at SCBC to provide 3D Mammograms. We have a total of 17 slots.

Slots are available for those who are:

  • 40 or Better

  • Women

  • With or without Insurance

For more information you can contact Claudette Overton (757)420-2920 or Cora Bridgers (757)486-2564.

To REGISTER simply fill out the questionnaire below and someone will follow up with you.

Mammography Bus Registration Questionnaire:
check any of the following resources you have:
Check all that apply:
Have you ever had a Mammogram/Ultrasound of the breast?
Interpreter Needed:
Does Patient Need Assistance Standng?:
Are you currently having any of the followin breast complaints:
If YES, please circle one:

**We are only able to schedule a Screening Mammogram, without an order from a physician. Diagnostic mammography requires a referral from your physician.

Thank you! We’ll be in touch.

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