2024 Sabres Prostate Cancer Early Detection Event

Registration for this event has been closed, or there are no appointments currently available.

Personal Information

About You

First name *

Last name *

Date of birth * (mm/dd/yyyy)

Contact Methods

Your Patient's Email Address *

Your Patient's Phone number * (###-###-####)

Best time to call

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.

Yes No

May we leave a message if you're unable to answer? * Yes No

How did you find out about this event? *

Please Explain

Residential Address

Street address *

City *

County *

State *

Zip code *

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

In which state were you was the patientborn? *

Marital Status *

Smoking Status *

Are you Is the patient currently a Roswell Park patient? * Yes No

Patient MRN

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? * Yes No

Are you Black/African American? * Yes No

Do you have a known BRCA I/II mutation, a family history of BRCA mutation or other familial syndromes? * Yes No

About Your Family

Do you have a family history of prostate cancer? * Yes No

Are youIs the patient of Ashkenazi Jewish ancestry? * Yes No Unsure

2024 Sabres Prostate Cancer Early Detection Event

Personal Information

About You

Contact Methods

Residential Address

Please Select A Check-in Time

Demographics

About You

About Your Family

Physician & Insurance Information

About Your Primary Care Physician Optional

About Your Insurance Optional

Race & Ethnicity

About You Optional