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Mobile Mammography Partnership Request Form

Thank you for your interest in partnering with Mammogram Poster Girls, Inc. to host a Mobile Mammography Event. Please complete the form below so our board can review your request and determine availability.

Mobile Mammography Event Criteria

Mammogram Poster Girls, Inc. partners with Methodist Health System to provide Mobile Mammography services for approved community events. To ensure a successful and safe screening experience, the following criteria must be met. Weekday Mobile Mammography events are typically scheduled from 9:00 AM to 4:00 PM, Saturday Mobile Mammography events are scheduled from 9:00 AM to 2:00 PM.  The mobile unit arrives 30–45 minutes prior to the scheduled start time for setup. Event locations must be able to accommodate nine to ten standard parking spaces with an overhead clearance of at least 16 feet to secure the unit. A minimum of 15 appointments must be scheduled at least two (2) weeks in advance, with the ability to screen up to 17 mammograms during a Saturday event and up to 22 mammograms during a weekday event. Please note that the mobile mammography unit is not accessible for patients using wheelchairs or walkers; patients must be able to independently enter the unit and stand unassisted for approximately 20 minutes to receive a screening. On-site restroom access for staff is required for the entire time period.  Electricity is not needed.

Each partnering/requesting organization MUST provide promotion and outreach for the event (digital flyers and social media assets will be provided).

Your Name(Required)

Event Details

MM slash DD slash YYYY
Event Timeframe (start):(Required)
:
Event Timeframe (end):(Required)
:
Event Location(Required)
Is this an indoor or outdoor event?(Required)
Is there adequate parking space available for a mobile mammography unit (bus/truck)-nine to ten standard parking spaces?(Required)

Audience & Impact

Target Population (check all that apply):(Required)

Funding & Sponsorship

Will funding or sponsorship be provided to cover mammograms (cost/patient is approx.. $200—up to 22 patients can be scheduled for an event)?(Required)
Are additional sponsors or partners involved?(Required)

Event Support & Logistics

Has your organization hosted a mobile mammography event before?(Required)

Additional Information

Acknowledgment(Required)

We can only carry out our lifesaving mission with the generous support of our donors.

Our Impact

The Mammogram Poster Girls have funded thousands of screening mammograms and diagnostic procedures across North Texas fulfilling our mission to save lives—one mammogram at a time.

Mammogram Poster Girls Mammogram Poster Girls Inc. is a tax-exempt organization as described in Section 501(c)(3) of the Internal Revenue Code. Donations are tax exempt to the full extent of the Code. EIN 82-320475.

Mailing Address: 408 W. 8th St., Ste. 103, Dallas, TX 75208

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