West Midlands Breast Screening Programme

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Request or change appointment

Please only use this form if you wish to change an existing appointment or you have received notification that you are due to be screened and would like to make an appointment.

Your Preferences

I would like to: Change my appointment Cancel my appointment

Reason for changing your appointment
(not required when making a new booking)

Preferred screening site(s) *
Please select at least one site

Birmingham Women’s Hospital (Weds p.m., Fri p.m. and alternate Saturdays 9:00 a.m. to 4:18 p.m.)
Broadmeadow Health Centre (Monday to Friday)
Sparkbrook Health Centre (Monday to Friday)

Please select at least one site

Preferred day(s)

MondayTuesdayWednesdayThursdayFriday

Preferred time

Early MorningMorningAfternoon

At this stage we cannot guarantee a specific appointment but if you select your preferred date(s), day(s) and time, we will do our best to book a convenient appointment.

Preferred dates: 1^st choice 2^nd

Are you available at short notice?

YesNo

Your Details

Full name *

Please enter your screening reference number, this number is in the top right hand side of your invitation letter and is preceded with MBS.

Screening or NHS number *

Telephone number

Mobile number

Date of birth *

Additional Information

Please let us know if you have special requirements i.e. Implants, are unable to manage steps or have other mobility difficulties.

If you would like to receive an email confirmation please enter your email address here
Email Address