1. In the last three months, have you had any of the following symptoms (check all that apply):

Bleeding when you have a bowel movement or blood in your stool (bright red, black, or brick red)

Changes in bowel movements that last more than a few days (e.g., diarrhea, constipation, or changes in size or shape of stool)

New or worsening pain in your belly (e.g., persistent cramps)

Losing weight without trying

None of the above

2. Do YOU have any of the following conditions (check all that apply):

Colon or rectal cancer

Colon or rectal polyp

Inflammatory bowel disease

Ulcerative colitis

Crohn's disease

Lynch Syndrome (HNPCC)

Familial adenomatous polyposis (FAP)

Don't know / None of the above

3. Do any of your immediate FAMILY MEMBERS (biological parent, child, sibling) have any of the following conditions (check all that apply):

Colon cancer

Rectal cancer

Precancerous polyps in the colon or rectum

Lynch Syndrome (HNPCC)

Familial adenomatous polyposis (FAP)

Don't know / None of the above

Personal Information:

Full Name (First Last) Date Of Birth Phone Number Email Address

What's the best way to send you updates about colorectal cancer screening?

Text Message

MyChart

Personal Information:

Full Name (First Last) Date Of Birth Phone Number Email Address Mailing Address

What's the best way to send you updates about colorectal cancer screening?

Text Message

My Chart

Select which colorectal cancer test you would like to request:

Based on your answers, there are several screening options that are right for you. Request a colorectal cancer screening test:

FIT (at home stool test)

A FIT test will be given to you by your healthcare team to take home. To complete the test, you will be asked to collect a small sample of your stool to send to a lab for testing

FIT-DNA (at home stool test)

A FIT-DNA will be sent to your home. To complete the test, you will be asked to collect an entire bowel movement and a smaller sample of your stool to send to a lab for testing.

Colonoscopy (in clinic procedure)

A colonoscopy is a procedure that is completed in a hospital or clinic. During a colonoscopy, a doctor will place a thin tube with a camera inside your rectum to look for polyps or cancers throughout your colon and rectum. You will need to completely clean out your bowels (e.g., drink bowel prep solution) before the colonoscopy.

Thank you to the Colorectal Cancer Alliance for its partnership in developing this screening tool.

Find the right colorectal cancer screening test for you

1. In the last three months, have you had any of the following symptoms (check all that apply):

2. Do YOU have any of the following conditions (check all that apply):

3. Do any of your immediate FAMILY MEMBERS (biological parent, child, sibling) have any of the following conditions (check all that apply):

Personal Information:

What's the best way to send you updates about colorectal cancer screening?

Personal Information:

What's the best way to send you updates about colorectal cancer screening?

Select which colorectal cancer test you would like to request: