Jones Regional Medical Center Urgent Care - Anamosa

1795 Highway 64 East
Anamosa, IA 52205

UnityPoint Clinic - Express (Lindale)

153 Collins Road Northeast
Cedar Rapids, IA 52402

UnityPoint Clinic - Express (Peck's Landing)

1940 Blairs Ferry Rd.
Hiawatha, IA 52233

UnityPoint Clinic Urgent Care - Marion

2992 7th Avenue
Marion, IA 52302

UnityPoint Clinic Urgent Care - Westside

2375 Edgewood Road Southwest
Cedar Rapids, IA 52404

Cancer Risk Assessment Form

To learn more about your cancer risk, complete this form and click send. If it is determined that you are at an increased risk for developing cancer, you may make a confidential appointment to review your family's health history and develop disease prevention strategies that are right for you.

If you or your family members have any questions, please contact us at (319) 369-7816.

Name* Address* City* State* Zip* Phone Number* Email AddressDate of Birth- Personal Medical HistoryCancer (check all that apply)*I had cancer before age 50
I had cancer at age 50 or after Type of cancer* Father's Family (check all that apply)*Cancer before age 50
Cancer at age 50 or after Please specify who and what kind of cancer: (mother, uncle, aunt, cousin, grandparent)Mother's Family (check all that apply)*Cancer before age 50
Cancer at age 50 or after Please specify who and what kind of cancer (mother, aunt, uncle, cousin, grandparent)

Reset reCAPTCHA

St. Luke's Emergency Department

Jones Regional Medical Center Urgent Care - Anamosa

UnityPoint Clinic - Express (Lindale)

UnityPoint Clinic - Express (Peck's Landing)

UnityPoint Clinic Urgent Care - Marion

UnityPoint Clinic Urgent Care - Westside

Cancer Risk Assessment Form

The way we make people feel matters more than anything else.

Are you a current patient or new patient at UnityPoint Health?

St. Luke's Emergency Department

Jones Regional Medical Center Urgent Care - Anamosa

UnityPoint Clinic - Express (Lindale)

UnityPoint Clinic - Express (Peck's Landing)

UnityPoint Clinic Urgent Care - Marion

UnityPoint Clinic Urgent Care - Westside

Cancer Risk Assessment Form