This survey can be used to determine whether you are eligible for lung cancer screening. To help us understand whether you may qualify for lung cancer screening, we need to ask for information about your age and smoking history. Please click "Submit" when done to determine your eligibility for lung cancer screening and avoid using the back button. We ask for your name, email, and phone number so that a team member can assist with screening information.

We will not share any of your personal information outside of our team, and will only contact you if you select "yes" at the end of the survey. 


This survey was created by the American Lung Cancer Screening Initiative (ALCSI), a 501(c)(3) nonprofit dedicated to raising awareness about lung cancer and lung cancer screening. To learn more about the organization, visit

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