Online Booking for Breast Screening

Please fill in the form below. We will confirm your booking via email or phone within 10 working days.

*This form is only for paid screening services. If you wish to apply for the Breast Cancer Screening Pilot Program (Phase II), please fill out the form at this link separately:

https://docs.google.com/forms/d/e/1FAIpQLSf6MCzJ9Qt4_Mehxjk7LD4wxgHt-B0WKkSlI0DmbQbK3GKpeA/viewform

Name:

Ms. Mr.

Age:

40 years old or above Below 40 years old

Email:

Phone no.:

Services:

I would like to book the following service: (Please tick the appropriate box, you may choose more than one item)

2D Mammogram (Please ensure you are not pregnant on the date of examination) 3D Mammogram (Please ensure you are not pregnant on the date of examination) Ultrasound

Date:

1^st choice

2^nd choice

3^rd choice

Location:

Hong Kong Centre: 21/F, Jupiter Tower, 9 Jupiter Street, North Point, Hong Kong (Exit A, Fortress Hill MTR Station) Kowloon Centre: 28 Lung Cheung Road, Ngau Chi Wan, Kowloon

For enquiries or urgent booking: (Hong Kong Centre) 3143 7333 or (Kowloon Centre) 2597 3200

Remarks:

Verification Code: