FREE Mammogram Appointment Request

Thank you for contacting the Broward Region of the Breast and Cervical Cancer Program serving Broward and Martin Counties. Funding is available for a screening mammogram to women between the age of 40 and 64 without health insurance and who meet income requirements.

At any age, if you have a current breast condition, and without health insurance and meet income requirements, you may be eligible.

If over age 64 and you don't have Medicare or other health insurance and meet income requirements, you may be eligible.

To see if you are eligible, and to schedule an appointment, call (954) 762-3649 or answer the following questions to receive a call by the next business day. You can also email: FREEMammogram@flhealth.gov

Full Name

First NameLast Name

Contact Number*

Please enter a valid phone number.

Email Address

example@example.com

What is your Date of Birth*

Date of Birth

Are you at least 40 years of age?
Yes I am at least 40 years of age    No, I am younger than age 40.

Do you have Health Insurance?
Share of Cost is accepted for the FREE Mammogram
(Check if your insurance covers breast and cervical screenings, if it does not, then you may be eligible for a Free Mammogram)
Yes, I have health insurance that covers breast and cervical cancer screenings   No, I do not have health insurance that covers breast and cervical cancer screenings.

When was your last mammogram?
Year of last mammogram

What is the best time for your appointment?
Morning    Afternoon

What County do you live?
I live in Broward County    No I don't live in Broward County (List the county in which you reside below)

County Name

How did you hear about FREE Mammogram services?

Once this form is received and pre-eligibility has been determined, you will be contacted via email with an attached enrollment packet to complete. The email will come from FREEmammogram@flhealth.gov