Make a booking form

To make a booking, please call BreastScreen SA on 13 20 50. You will be asked some personal health questions, so please allow time to answer these when phoning. Alternative, fill in your details below and we will contact you.


  1. The purpose of submission of this information is to request contact regarding an appointment for a breast screening service.
  2. The information will not be used for any other purpose and will be confidentially disposed of after 3 months.
  3. This form is an embedded third party application and information is managed through the service provider in USA.
  4. Please read SA Health Disclaimer and Privacy notice for further information.

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