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How Do I Enroll ?

Participants of the Breast and Cervical Cancer Project (BCCP) are enrolled in the program based on the county of Ohio that you live in. There are four Regional Enrollment Agencies located throughout Ohio. The regional agency staff will explain the program and assist you with obtaining your recommended breast and cervical cancer screenings.

With patient navigation, regional agency staff can guide women through the healthcare system, find providers and community resources, answer questions about scheduling appointments and using insurance, and more.

The regional agency staff will also review your eligibility for no-cost breast and cervical cancer screenings.

Please review the map below to determine which Regional Enrollment Agency you should use based on the county in which you live:

Map of Breast and Cervical Cancer Project (BCCP) Regions


Once you have determined which Regional Enrollment Agency which you live in, you can complete an Enrollment Form online. Select the Regional Enrollment Agency link that will take you a HIPAA- Compliant Form Doctor enrollment form. Once you have completed the form, a representative from the appropriate Regional Enrollment Agency will contact you and guide you through the process of becoming a participant of the BCCP program.

Enrollment Form Links:

Northern Region

English Enrollment Form

Spanish Enrollment Form


Central Region

English Enrollment Form

Spanish Enrollment Form


Southwest Region

English Enrollment Form

Spanish Enrollment Form


Southeast Region

English Enrollment Form

Spanish Enrollment Form