Application Guidelines

• Age 40 and above unless medically necessary at a younger age.
• Must have financial need based on total combined yearly household income. (See application for details)
• Only full-time Florida residents are eligible to apply with proof of residency. Attach one of the following: copy of Florida drivers license, Florida Voter Registration Card, or Florida ID to application.
• You may submit only one application in a twelve (12) month period.
• Prescription for mammogram (from healthcare provider) must be attached to completed application.
• You must go to a Dollars for Mammograms assigned facility to ensure payment of mammogram.
• Failure to provide accurate information and/or follow our guidelines may result in current and/or future rejection from this program.