Mobile Mammography Clinic Request Form

Are you looking to bring the Owensboro Health Mobile Mammography Clinic to your workplace, event or organization? Our team is ready to help. Contact the Owensboro Health mobile mammography team at MobileMammoClinic@OwensboroHealth.org or use the online form below.

Request Form

Denotes required fields

Your Organization

Name of your organization or business

City

Type of organization

Business

Non-profit

Other

Your Event

Brief description of your request

Proposed date

Number of people expected

Is a restroom available for our team to use?

Where should the bus be parked?

Bus Dimensions: 38’10” x 8’5” x 11’8”

Your Contact Information

First name of primary contact

Last name

Phone

Address

City

State

ZIP Code

Additional Information

Are there more details we need to know?

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