You may be eligible for a FREE mammogram or cervical cancer screening if you are unable to pay because of insurance or income. If eligible, services would be provided through the Hawai‘i Breast and Cervical Cancer Control Program (HBCCCP).

Please complete this form and a staff member will contact you within 5-10 business days.

    Breast screening (mammogram)

    Cervical screening (Pap/HPV test)

    21-29

    30-39

    40-64

    No

    I have health insurance, but it has co-pays and deductibles that are not affordable.

    O‘ahu (Honolulu)

    O‘ahu (Windward)

    O‘ahu (Central)

    O‘ahu (Leeward)

    O‘ahu (North Shore)

    Hawai‘i Island (Hilo)

    Hawai‘i Island (Kona)

    Kaua‘i

    Maui

    Moloka‘i

    Lānaʻi

    Yes

    No

    Family Size

    Annual Income is at or below

    Monthly Income is at or below

    1

    $45,900

    $3,825

    2

    $62,225

    $5,185

    3

    $78,550

    $6,546

    4

    $94,875

    $7,906

    5

    $111,200

    $9,267

    6

    $127,525

    $10,627

    7

    $143,850

    $11,988

    8

    $160,175

    $13,348

    Additional Family Member: $16,325/year or $1,360/month

    Community/outreach event

    Radio ad

    Flying/Poster

    TV ad

    Social Media

    Friend or Family member

    Searching on Google

    Doctor/Nurse/Clinic

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