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:
Age:
Email:
Phone no.:
Services:
I would like to book the following service: (Please tick the appropriate box, you may choose more than one item)
Date:
1st choice
2nd choice
3rd choice
Location:
For enquiries or urgent booking: (Hong Kong Centre) 3143 7333 or (Kowloon Centre) 2597 3200
Remarks:
Verification Code: