Contact the Sentara Cancer Network
Thank you for your interest in the High Risk Lung Cancer Screening. Fill out the form below with your contact information and our coordinator will get back to you within 24-48 hours.
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First Name:*
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Daytime Phone:*
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Date of Birth:*
Current Smoker:*
If you are not a current smoker, when did you quit?
How many years have you smoked:*
How much have you smoked?:*