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Wellness Vending Machine

The Eagle Pass Public Health Coalition is partnering with My BIO TESTS to bring a Wellness Vending Machine to our community, making essential health and wellness products easier to access.

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Community members can apply for access to the machine and, once approved, receive eligible wellness essentials at no cost.

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From personal care products to everyday health resources, the Wellness Vending Machine helps bring convenient, confidential access to the essentials people need.

Apply today to get access to the Wellness Vending Machine.

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Registration for the Eagle Pass Wellness Card Program

Your information is confidential and used only for program enrollment, service coordination, and grant reporting.

1 - CONTACT & ELIGIBILITY

Birthday
Month
Day
Year
Preferred Contact Method
Current Status
Pregnant
Postpartum
Trying to Conceive
Not Applicable
How did you hear about this program?
Estimated Annual Household Income
Less than $10,000
$10,001 - $30,000
$30,001 - $50,000
$50,001 or more
Prefer not to answer

2 - DEMOGRAPHICS

Race / Ethnicity (select all that apply)
Primary Language Spoken at Home
English
Spanish
Other
Household Income Range (or Federal Poverty Level bracket)
Under 100% FPL
100-138% FPL
139-200% FPL
Over 200% FPL

3 - INSURANCE & EMPLOYMENT

Insurance Status
Medicaid
Private Insurance
Uninsured
Other
Employment Status
Employed Full-Time
Employed Part-Time
Unemployed
Student
Unable to Work
Highest Level of Education Completed
Less than High School
High School/GED
Some College
College Degree+

4 - HEALTH & RISK FACTORS

Any High-Risk Conditions (self-reported; select all that apply)
Currently Receiving Prenatal/Postpartum Care?
Yes
No

5 - MENTAL HEALTH SCREENING (OPTIONAL)

Over the past 2 weeks, how often have you felt down, depressed, or hopeless?
Not at all
Several days
More than half the days
Nearly every day

6 - SOCIAL DETERMINANTS OF HEALTH

Housing Stability
Stable Housing
At Risk of Losing Housing
Currently Unhoused
Reliable Transportation to Appointments?
Yes
No
Sometimes
Within the past 12 months, did you worry your food would run out before you had money to buy more?
Never True
Sometimes True
Often True
Access to Reliable Childcare?
Yes
No
N/A

7 - PROGRAM FIT

What support are you hoping to receive? (select all that apply)

8 - CONSENT & AUTHORIZATION

I Consent
I consent to the collection and use of the information provided above for program enrollment, service coordination, and reporting to program funders. I understand my information will be kept confidential and used in accordance with applicable privacy laws.
Today's Date
Month
Day
Year
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