2024 Sabres Prostate Cancer Early Detection Event

Please complete the form below to determine if you are eligible for the Buffalo Sabres and Roswell Park prostate cancer early detection clinic on Monday, May 13, 2024, at KeyBank Center. The clinic will run from 3 – 7 p.m.

Fields marked with an asterisk * are required.

Pre-registration for this event has closed; however, walk-ins for the early detection testing are welcome and will be considered for the testing based on screening eligibility criteria. All are welcome to attend for prostate cancer education.

Personal Information

About You

Contact Methods

May we say we're calling from Roswell Park? *

Due to HIPAA regulations, Roswell Park will not be able to identify itself to someone other than you or in a voice message, unless you indicate otherwise.

May we leave a message if you're unable to answer? *

Please Select A Check-in Time

You should arrive for check-in at this time, but please note this is not an appointment time. You may still experience some wait times. During your wait you will be invited to visit educational tables, meet Sabres alumni, enjoy refreshments and more.

Demographics

About You

Are you Is the patient currently a Roswell Park patient? *

These details are required to determine if you are eligible for a prostate screening.

Are you currently a patient of our Genitourinary (GU) Cancer Center?  *
Are you Black/African American?  *
Do you have a known BRCA I/II mutation, a family history of BRCA mutation or other familial syndromes?  *

About Your Family

Do you have a family history of prostate cancer? *
Are youIs the patient of Ashkenazi Jewish ancestry? *

Physician & Insurance Information

About Your Primary Care Physician Optional

About Your Insurance Optional

Race & Ethnicity

About You Optional

Please indicate how youthe patient identify yourselfidentifies themselves Mark all that apply.
Are youIsthe patient Spanish/Hispanic/Latino?
Are youIs the patient Mark all that apply.
Do youDoes the patient accept interpreter services?