Buddy Bus Patient Registration - Florida Department of Health in St. Johns County

Thank you for choosing the Baptist MD Anderson Cancer Center's Buddy Bus for your annual mammogram. Once this form has been submitted, you can expect a phone call from our scheduling team one week before the scheduled event.


EVENT TIME: 10:00 a.m. - 1:00 p.m.

EVENT DATE: Saturday, September 7, 2024

EVENT LOCATION: Solomon Calhoun Center - 1300 Duval St, St. Augustine, FL 32084



Questions?

Please contact BuddyBus@bmcjax.com



This form will take 5 minutes to complete.

Patient Information

NOTE

If you are under the age of 40, we recommend you call your insurance company to see if a screening mammogram is covered.

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Insurance Information

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If you do not have insurance or your carrier is not listed please type N/A.

Are you the policy holder?*

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Mammography Questionnaire

Is this your first mammogram?*

Phone
Phone

Please include city, state, and zip code.

According to the American College of Radiology, pregnant patients can receive screening mammograms.

Pregnant women under the age of 30 at high risk for breast cancer, pregnant women age 30 to 39 at medium or high risk for breast cancer, and pregnant women 40 and older should receive screening mammography with lead shielding to minimize radiation exposure to the fetus.

Feb 27, 2019

Do you have breast implants?*

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