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 ever had a mammogram?
Yes
No
*
6. Have you ever had a Pap test?
Yes
No
*
7. Do you have a breast mass?
Yes
No
*
8. Do you have abnormal vaginal bleeding?
Yes
No
*
9. 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.
10. 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.