ColoHeath Patient Registration Please answer the following questions to determine your eligibility for the ColoHealth™ Test. Are you 50 years of age or older?(Required) Yes No Have you declined the recommended U.S. Preventive Services Task Force (USPSTF) colorectal cancer (CRC) screening methods such as fecal tests, sigmoidoscopy, and/or colonoscopy?(Required) Yes No Have any of your close relatives (parent, sibling, child) been diagnosed with CRC, precancerous polyps or hereditary colorectal cancer syndromes such as familial adenomatous polyposis (FAP) or Lynch syndrome?(Required) Yes No Do you have a history of CRC, polyps, inflammatory bowel disease, or hereditary CRC syndromes?(Required) Yes No Are you having any of the following symptoms: A change in bowel habits including diarrhea, constipation, or narrowing of stool that persists over a couple of days. Constant changing in bowel habits – e.g., feeling like there is bowel movement that is not relieved by passing stool. Rectal bleeding with visible red blood. Blood in the stool, which can change the appearance of stool to look dark brown or black. Abdominal cramping or pain. Weakness and fatigue. Inexplicable weight loss.(Required) Yes No EmailThis field is for validation purposes and should be left unchanged.
