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Lung Cancer Screening Request

If you are between the ages of 55 and 77 years old, and if you are a current or former tobacco smoker, you may be eligible to participate in a screening program. The Lung Cancer Screening program was developed to assist patients in the early detection of lung cancer and the good news is most insurance companies do not charge copay or deductible for the screening. Please complete the following questions and someone from the Lung Cancer Screening team will contact you within 24-48 business hours.

* Asterisk indicates required field.

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Criteria
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If you are a former smoker, have you quit within the last 15 years?

Note that if you quit smoking more than 15 years ago you may not qualify for the screening.
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Location Preference
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