SPIPA Mobile Mammogram Survey

SPIPA Native Women's Wellness Program Mobile Mammogram Bus

SPIPA office next Swedish Mobile mammo bus date Fridays, Friday June 27, 2025. The NWWP helps to pay for the cost of breast and cervical cancer screenings for women who are eligible for the program. The information being asked below will be used to determine your eligibility for the NWWP.

*The mobile coach is only accessible by stairs; patients should be able to walk up and down 6 stairs easily and remain standing during their appointment. Income information is only used to determine eligibility for free or reduced screening costs.

FAQs about Swedish mobile mammography coach before scheduling your appointment.

Q: Who can get a screening mammogram on the mobile coach?

A: Women over the age of 40 who have not had a mammogram in the past year may get their annual screening mammogram on the mobile coach.

Q: Do I need a referral for a mammogram?

A: No referral is needed for women over the age of 40 who have not had a mammogram in the past year. Women aged 32-39, will need a referral for a screening mammogram from their provider. Women aged 39 and under must have their screening performed at a breast center.

Q: Who is considered high risk for breast cancer?

A: A mother, sister or daughter have been diagnosed with breast or ovarian cancer in their 40's or younger. Testing positive to BRCA1/BRCA2. Treated with chest radiation for Hodgkin's disease. High risk patients do not need a referral.

Q: Can women with breast implants be screened on the mobile unit?
A: YES.

Q: Who should NOT have a mammogram with the mobile coach?
A: If you are experiencing breast pain, nipple discharge, lumps, or are recently diagnosed with breast cancer, please check with your primary care provider to discuss further recommendations, testing or referrals. If your last mammogram results needed additional imaging, you should be seen at a Breast Center.

*Women who are pregnant or breastfeeding should be seen at a breast center.

Q: Is the mobile coach ADA accessible?
A: Unfortunately, no. However SPIPA NWWP can assist you in locating a ADA accessible breast center.
Q: Do I need to be Vaccinated for COVID-19?

A: No, all patients are welcome regardless of vaccine status.

Q: How will I get my results?

A: Results will be sent to you and your PCP by mail or MyChart in 7-10 days.

Still unsure? Contact Delia Culp at 360-426-3406 or call/text 360-968-3768

1.Patient Information(Required.)

Name: First, M, Last

Date of birth:

SSN:

Street address, city, state, and zip:

Best phone number:

Alternate phone if applicable:

Email address:

Confirm email address:

Last mammogram date:

Previous mammogram location:

2.Ethnicity (Please Select all the apply)(Required.)

3.Are you a tobacco user?(Required.)

Yes

4.Do you have health insurance?(Required.)

Yes

5.If you answered yes to the question above, please select your insurance (Select all that apply)(Required.)

Medicaid/Medicare

Other Insurance (Please specify)

I do not have health insurance

6.Insurance card information(Required.)

Insurance company

Member ID

Group number

7.Please tell us how many people currently live in your household.(Required.)

8.Please provide your gross annual income *Income information is only used to determine eligibility for free or reduced screening costs.(Required.)

9.Do you have a current health care provider?(Required.)

Yes, please be prepared to enter primary care providers first and last name.

10.Primary Health Provider Information(Required.)

Healthcare provider name

Street address

City, State

Phone number

11.If you are between the ages of 35-40, do you have a referral?(Required.)

Yes, Please bring with you to your appointment.

No, we can only screen women aged 35-40 with a referral from a health care provider or if you meet the high risk criteria on the first page under conditions.

I am 40, or above.

12.Please Select all that apply(Required.)

A mother, sister or daughter have been diagnosed with breast or ovarian cancer in their 40's or younger

I have tested positive for BRCA1/BRCA2

I have been treated with chest radiation for Hodgkin's disease

None of the above

14.Preferred contact method(Required.)

Phone call

Text

15.Is this your first mammogram screening?(Required.)

Yes

16.Do you have breast implants?(Required.)

Yes

17.Do you need assistance with transportation or gas to attend your appointment screening?(Required.)

Yes