First Responders Screening Program

Please be aware this program is usually covered by insurance, however, you may be responsible for a copay. If your insurance requires a referral, you will need to obtain one from your doctor.

To determine if this program is appropriate for you please answer a few brief questions.

Please complete the assessment below to determine if this program is appropriate for you. If you are eligible, a referral specialist will contact you within two business days to gather more detailed information.

You may also call 1-800-ROSWELL (1-800-767-9355) to schedule an appointment.

Your Information

Are you the patient? *

Have you ever been seen at Roswell Park?

Has this individual ever been seen at Roswell Park?

Your Patient's Contact information

Would you like to join our mailing list?

Best method to contact?

Program Questions

Have you ever been a first responder?

Please select which type(s) of first responder you have been:

This is a placeholder for police-specific questions.

Which of the following roles do you typically perform on the scene of a structure fire?

Please check all that apply, current or past.

Have you responded to any commercial fires?

This is a placeholder for EMT-specific questions.

Did you respond to 9/11?

Are you enrolled in the WTCHP?

Please take a moment and check your eligibility for the WTCHP.

Do you have a second job in addition to being a first responder?

Does your second job involve manufacturing or fabricating any of the following?

During your second job are you exposed to any of the following?

Are you exposed to second-hand smoke while at work?

In the last year have you had any of the following tests:

In the last five years have you had a chest x-ray?

In the event of cancellation, are youis the patient interested in same or next day appointments?

Your Patient's Insurance information

Are you covered by any kind of health insurance or some other kind of health plan?