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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.

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This is my:

I meet the following high risk criteria:

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2701 North Decatur Road Decatur, GA 30033
404.501.1000
Patient Inquiries: 404.501.5200

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