EmpowerHER Screening for Hope Program

Aimed at empowering women in our community to prioritize their health. Early detection is crucial, and we believe that financial barriers should never stand in the way of vital screenings.

Through this initiative, we are providing vouchers that cover the cost of mammogram screenings for women who may not have access otherwise. Our goal is to ensure that every woman has the opportunity to get screened and stay healthy.

Please complete this form to be eligible to receive a mammogram screening voucher.

Name

First Name

Last Name

Phone Number

Residential Address

Date of Birth

YYYY

Are you currently experiencing any breast health issues?

Yes

Have you previously undergone mammogram screenings?

Yes

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