16 Buddy Check

16 Buddy Check encourages women to take an active role in detecting breast cancer early through breast self-examination. NewsCenter16 and The Women’s Task Force of St. Joseph Regional Medical Center will become your "buddy" and remind you by e-mail each month to perform your breast self-examination.

16 Buddy Check is a free service. To join, register online using the form below.

How to participate:

Choose a buddy -- a friend, sister, mother or co-worker.

Complete the registration form below.

On the 16th of each month, check with your buddy to make sure she's doing her monthly exam and an annual mammogram if she's 40 or older. If either of you notice any changes in your breasts, see a physician as soon as possible.

1.Contact Information:

First Name*		M.I.		Last Name*

Email Address*		Daytime Phone		Evening Phone

2.Address:

Street Line 1

Street Line 2

City

State / Province

Country

Zip / Postal Code

3.Gender*

	Male

	Female

4.Are you currently performing breast self-exams?*

5.On a scale of 1 to 10, with 10 being very confident, how confident are you in your ability to perform an accurate BSE?*

6.If you're over 40, do you have an annual screening mammogram?*

7.Invite your Buddy to sign up for 16 Buddy Check

Your Buddy's First Name

Your Buddy's Last name

Your Buddy's Email Address

8.Please enter your date of birth.

Month*		Day*		Year*

9.Terms and Conditions

I have read, understand, and agree to the Website usage agreement and privacy policy.

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