Pink Campaigns






Keep Project Mammograms FREE

Donate Today!




Free Breast Cancer Screening


Free Breast Cancer ScreeningMany women at risk for breast cancer in this country are under insured or do not have any health insurance at all.


At PINK CAMPAIGNS your health and well being is priority one. SOLUTIONS FOR THE CURE through early detection, prevention and awareness. Now you have no excuse for not having a mammogram every year.


The solution for the cure is; beating it before it has a chance to start.

At Pink Campaigns we offer Project Free Mammograms to all as part of early detection.



 Stay informed of dates and times for the Mobile Screening Unit With our monthly Newsletter.


Mammography Support Request

If you are at least 18 years of age, and are uninsured or underinsured, Pink Campaigns, Inc. may be able to pay the total cost or help supplement the cost of a mammography at a location in your area. Our goal is to ensure all women over 18 receive a baseline mammogram and that lack of ability to pay does not prevent any woman from receiving the medical treatment she needs. Early detection is critical. 

You may be required to furnish documentation of your current financial status and/or insurance.

  Personal Information
Full Name:
Daytime Phone: ( )
ZIP: -
Sex: Female Male
  Employment Information
Employment Status: How Long? Months or Years
Household Income .00
Employers Name
Telephone - -
Employers Address
City, State, Zip Code , , -
  Insurance or Medicaid/Medicare Info
Physicians Name
Telephone - -
Physicians Address
City, State, Zip Code , , -
Date of Last Mammography , Over 12 years ago.Check
  Information About your Symptoms
Have you noticed any new changes in your breast recently which are not related to monthly discomfort? Yes No
In which breast? Left Right Both
Which of the following apply?
Change in Shape
Unusual Pain
Inverted Nipples
Persistent Nipple Discharge
How long ago was your last breast screening? What type of screening? (years)


Is there a history of breast cancer in your family?
If so, what is the relation?
Yes No Don't Know Relation
Who's side of the family had this history of breast cancer?
At what age?
Mother's Father's Age (if known)
How did you hear about Pink Campaigns Project Free Mammogram?
Would you agree to share your experience with Pink Campaigns? Yes   No
Please include any additional comments, questions or needs you may have.


The next page we give the option for our Newsletter.



















































































Click here to sponsor a mammogram today!








AmerinRio, Inc. | 25325 SW 202nd Ave.| Homestead | FL | 33031

AmerinRio is a registered U.S. 501(c)(3) charitable organization.

GuideStar: the leading source of information on U.S. nonprofits.




myspace profile visitors