Instructions:
To determine if you may be eligible for BreastCare services, please answer ALL questions that appear and then click on the 'Check eligibility' button.
1. Are you a female?
Yes
No
2. Are you an Arkansas resident?
Yes
No
3. Do you have health insurance?
Yes
No
4. What is your birth date? (Format: mm/dd/yyyy)
5. Have you had a normal mammogram in the last 12 months?
Yes
No
6. Have you had a normal Pap test in the last 12 months?
Yes
No
7. Do you have a breast mass or abnormal vaginal bleeding?
Yes
No
8. What is your gross monthly household income?
You must count alimony, Social Security, and retirement as part of your income. Do not include high school or college student earnings.
9. How many members are in your household?
-- Select a number --
1
2
3
4
5
6
7
8
9
10
11
12
13
Click 'Check Eligibility' button to determine if you are eligible.