Answer the following questions and your answers will be emailed to us. We will evaluate your answers and we will email you whether you have a high, medium or low risk of developing breast cancer. On the same email, if you would like more information on the Woman's Breast Center or would like to make an appointment for a mammogram and to see a physician, please put your name and phone number in the email so we may contact you.

1. What is your present age?

2. Have you had children?

3. Your age when you had your first child?

4. Are you in menopause?

5. Have you had cancer of the breasts?

6. Do you have a family history of breast cancer?

7. If you have a family history, was it with:

8. Are you 20 pounds or more overweight?

9. Have you had a breast biopsy?

10. Have you had cancer of the:

11. Have you had radiation to the:

12. Please enter your email address to be contacted for results: