Urologic Cancer Risk Assessment

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?


Has this individual ever been seen at Roswell Park?

Would you like to join our mailing list?

Patient's Contact Information


Eligibility

Do you have difficulty with urination? *

Have you noticed blood in your urine? *

Do you have a hyperactive bladder? *

Do you have issues with the sudden urgency to urinate? *

Do you have difficulties with erections and/or ejaculation? *

Do you have pain in your flank? *


Flank pain is pain in one side of the body between the upper belly area (abdomen) and the back.

Has your primary care physician told you that your PSA is elevated? *

Do you have scrotal swelling and/or pain? *

Are you suffering from kidney stones? *