High Risk Anal Cancer Screening

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.

Contact Information

Are you the patient? *

Have you ever been seen at Roswell Park Cancer Institute?


Has this individual ever been seen at Roswell Park Cancer Institute?

Would you like to join our mailing list?

Patient's Contact Information
Eligibility

Have youHas the patient been diagnosed with HIV or AIDS?

Are youIs the patient a transplant patient with a documented HPV infection?

Are youIs the patient male or female?

Male

Have youHas the patient been diagnosed with high-grade dysplasia of the penis?

Have youHas the patient had sex with another man?

Female

Have youHas the patient been diagnosed with high-grade dysplasia of the cervix or genitals?