Apply for a Free Mammogram**

This program is designed to help low-income, uninsured women who are permanent residents of the State of FL receive a one-time free mammogram.

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Name
Are you currently employed?
Do you have health insurance?
Are you a permanent resident of the State of FL?
You may be asked to provide a copy of a picture ID and/or a copy of a utility bill such as electric, water, cable, or other verifying your name and permanent address.
Have you ever had a mammogram?

**NOTE: This application is for consideration for a free mammogram while the funds are available during the month of October 2024.  Please note that you will need an order from a doctor in order to receive a mammogram.