No Referral Needed

Annual lung cancer screenings are an important part of a proactive health care plan for current and former smokers. Most people with a smoking history over the age of 50 qualify for a lung cancer screening. These screenings can identify potentially cancerous abnormalities like lung nodules long before any symptoms occur.

Please complete this online form to begin the appointment scheduling process.

American College of Radiology Lung Cancer Screening Center logo, Lung Cancer Center of Excellence logo, American College of Radiology Acreditted Facility logo

Appointment Qualifications

Are you 50 years of age or older?

Yes

Please enter the number of years that you smoked cigarettes:

What is the average number of cigarette PACKS smoked per day?

Have you ever had a Lung Screening CT before?

Yes

Do you have a primary care provider?

Yes

Are you interested in smoking cessation resources?

Yes

Patient Insurance Information

Primary insurance

Policy ID number

Is the patient the insurance holder?

Does the patient have secondary insurance, or a Medicare Supplement (Medigap) Plan?

Request a Lung Screening

No Referral Needed

Appointment Qualifications

Appointment Preferences

Patient Contact Information

Patient Insurance Information

Request a Lung Screening

No Referral Needed

Appointment Qualifications

Appointment Preferences

Patient Contact Information

Patient Insurance Information

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