Make a group booking request form Breadcrumb Home Health Topics Cancer Screening Breast Screening Group Bookings Make a Group Booking Request Form Listen Print Main navigation Cancer screening Breast screening About breast cancer Getting a breast screen BreastScreen Tasmania BreastScreen Tasmania Mobile Units Make a breast screening appointment Group bookings Make a group booking request form Breast Care Nurses Bowel screening Cervical screening About cancer Cancer screening information for health professionals Publications and resources for cancer and cancer screening Useful links for cancer screening About Population Screening and Cancer Prevention Contact Population Screening and Cancer Prevention Complete the form below to request a group breast screening appointment. You must have JavaScript enabled to use this form. First name Surname Address Street name and number Suburb State Post code Preferred contact method Phone Email Email address Telephone number Preferred call time Maximum number of women in your group Preferred appointment location If you select mobile unit, please enter your preferred mobile unit location in the Comments field at the end of this form. View mobile unit itinerary (dates and locations) Hobart Launceston Mobile unit Appointment date first preference Appointment time - first preference am pm Appointment date second preference Appointment time - second preference am pm Appointment date third preference Appointment time - third preference am pm Comments