Colonoscopy Screening Survey

Are you 45 years old or older?
In the past 3 months, have you had any of the following symptoms?
Which of these statements best describes you?
Have you ever completed a stool test?
If test is positive, do you agree to proceed with a colonoscopy?
If test is negative, do you agree to repeat testing in 3 years?
Please provide us with your contact information.
Patient Name
Address Information
Contact Information

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