Thank you for giving me the chance to have a mammogram done. – Conchita C.

Words cannot express my appreciation!! -Beth Finamore-Neff

Early detection programs has played a big role – KARM

UCSF has shaped the human service foundational experience – Ms. Jacqueline G. McRae-Mitchell

We are so appreciative of Mercedes and all her staff and helpers. – Mayor Dale Perdue and Staff

(855) 622-6237

Screening Mammography Application

Screening Mammography Application

The inability to pay should not prevent you from receiving preventive care. If you are uninsured or underinsured, the United Cancer Support Foundation can assist you with getting a mammogram at no cost to you. To receive a quicker response, please answer all questions. If you have any questions, please give us a call at 865.474.1511. Funds are only available for mammograms (screening or diagnostic). (Note: This free service is currently not available in the following states: Michigan, Minnesota, New York, Iowa, Oregon, and Utah.)

Healthcare Coverage
If covered, check one for type:
Race and Ethnicity (Check one)
Are you currently employed?

History and Client Information Form

2. Have you received a mammogram from USCF or ABCSA in the past?
What were the breast exam results?
3. Have you ever had a mammogram?
4. Have you had a clinical breast exam in the last year?
5. *Please check if you have any of the following symptoms:

*If you have any of these symptoms, you need to have a doctor's order from your physician or local health department.

6. Do you have a history of cancer?
7. Do you have a family history of cancer?

All information is confidential and used to determine eligibility. If approved, all payments are made directly to imaging and radiology providers. Submission of this application does not imply or guarantee approval of financial assistance. Applications are reviewed and evaluated to aid those with the greatest need.