Midland Eligibility Screening Tool Fill out this free screening tool to see if you qualify for programs to help pay for your medical bills. If you qualify, a Midland advocate will contact you to help you apply for those programs. Please enable JavaScript in your browser to complete this form.Name *FirstLastPhone Number *EmailState *Your StateMissouriOklahomaIllinoisWisconsinFacility/Clinic Name *Comment or MessageSubmit