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Apply for Screening Assistance
in English or Spanish

Screening Assistance Form
By Panhandle Breast Health and in collaboration with Haven Health Clinics
By filling out this form, you are stating that you are interested in getting information from Panhandle Breast Health about a free mammogram, low-cost pap smear, or low-cost HPV vaccination.

Formulario de asistencia de detección
De Panhandle Breast Health en colaboración con Haven Health Clinics
Al rellenar este formulario, usted está declarando que está interesada en obtener información de Panhandle Breast Health sobre una mamografía gratuita, una prueba de Papanicolaou de bajo costo o una vacuna contra el VPH de bajo costo.
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