Breast and Cervical Cancer Screening

How to Apply

Call 240-777-1750 to apply.  

Application (English)
Application (Spanish)

Provider Client Referral Form

Documents To Bring

Provide one proof of income from the following list: 

  • Your signed Federal income tax return (most recent) and schedule C if applicable
  • Your most recent W-2 statement
  • Your two most recent pay stubs with your name and address   

Provide one proof of your Montgomery County residency from the following list:

  • Maryland State ID Card
  • Lease Agreement
  • Mortgage agreement
  • School records
  • Voter registration card
  • Motor vehicle registration
  • Current driver’s license
  • Any one utility bill (except cell phone). 

Eligibility Requirements

  • Women must be between 40 and 64 years of age
  • Montgomery County resident
  • Uninsured and have household income at or below 250% of the federal poverty guidelines.
  • Proof of income such as pay stubs and income tax returns.  

Women who are visitors to the United States are not eligible for this service but obtain information about other community resources

Fees and Payments

This service is free to eligible participants


1.  What is the Women’s Cancer Control Program?

The program provides free mammograms, clinical breast exams and pelvic exam, Pap tests and follow-up care.

2.  If I am not working and a family member claims me on their taxes, can I still apply to   this program?

Yes, however your family member must submit income information (Federal Income Tax return) to demonstrate that you meet the program eligibility requirements (family income must be less than 250% of the Federal poverty guidelines) based on family size.

3.  How long does it take to be approved for this program?

Once we receive all of your required document, it usually takes at least one to two weeks to review your application for completeness and to determine if you are eligible for services.

4.  When and how will I know if I’m approved?

We will mail a letter to you at your current address to let you know if you are approved.  If you are approved, the letter will include a screening exam voucher(s) for mammogram, pelvic exam and pap or clinical breast exam.  We will also include a list of participating radiology providers (for the mammogram) and physicians so you may call a doctor or clinic convenient to you and schedule your exam appointment. 

5. What happens after the test, how will I know the results?

Normal exam results will be mailed to your home address.  If the results are not normal or you need additional or follow-up exams, a nurse case manager will contact you to explain the results, give you further instructions and assist you as needed.  


 Additional Information

No additional Information at this time