UnityPoint Clinic - Express (Peck's Landing)

1940 Blairs Ferry Road
Suite 104
Hiawatha, Iowa 52233

Urgent Care - Anamosa

1795 Hwy 64 East
Anamosa, Iowa 52205

Urgent Care - Hiawatha

1001 N. Center Point Road
Suite A
Hiawatha, Iowa 52233

Urgent Care - Marion

2992 7th Ave.
Marion, Iowa 52302

Urgent Care - Westside

2375 Edgewood Rd SW
Cedar Rapids, Iowa 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)

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St. Luke's Emergency Department

UnityPoint Clinic - Express (Peck's Landing)

Urgent Care - Anamosa

Urgent Care - Hiawatha

Urgent Care - Marion

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

UnityPoint Clinic - Express (Peck's Landing)

Urgent Care - Anamosa

Urgent Care - Hiawatha

Urgent Care - Marion

Urgent Care - Westside

Cancer Risk Assessment Form