Tell us about Yourself

In order to better serve the community it would help us if we get to know you.

Just click on answers.


Have you ever had a cancer screening?

Yes No

If so, what kind of screening? (click on more than one answer if you have had more than one test):

Mammography Pap Test Sigmoidoscopy Hemocult PSA testing

Do you currently smoke?

Yes No

Do you want to quit smoking?

Yes No

 Do you know anybody with cancer?

Are you:

Male Female

What level of schooling have you completed:
No official schooling
Elementary school
High School
Vocational School
Graduate School
How old are you?

Where do you live (enter zip code):

Do you have medical insurance?

Yes No