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Lung Cancer Screening Form

Complete and submit this form to register for your lung cancer screening. Please note: If you do not meet the High Risk criteria, you are not eligible for this screening. Once this form is received, a DeKalb Medical representative will call you to schedule your screening.

Use format (xxx) xxx-xxxx , xxx-xxx-xxxx, or 1-xxx-xxx-xxxx

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DeKalb Medical Cancer Center
2675 North Decatur Rd.
Suite 103
Decatur, GA 30033

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    404.501.SCHD (7243)

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