Lung Cancer Screening

Full Name*

Email*

Phone*

Date of Birth (must be 50-80 years old to qualify)*

Are you a current smoker?

Are you a former smoker that quit no longer than 15 years ago?*

Have you had any previous lung cancer diagnosis?*

Have you had a lung cancer screening in the past 12 months (if so, you would not qualify)?*

Do you have active medical insurance? (if so you would qualify)*

How did you hear about us?*

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5111 S. Ridgewood Avenue, Suite 101, Port Orange, Florida 32127 , United States

NOROVIRUS STUDY

Full Name*

Email*

Phone*

Date of Birth (must be 60+ years of age to qualify)*

Do you have colitis (IBS)?*

Are you immunocompromised? (psoriasis is ok)*

Have you had any diagnosis of cancer in the last 2 years? (nonmelanoma skin cancer is ok) *

How did you hear about us?*

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5111 S. Ridgewood Avenue, Suite 101, Port Orange, Florida 32127 , United States