Lung Cancer Risk Assessment

Your Name

First NameLast Name

Your Age

Enter your age as a whole number

Email

example@example.com

Phone Number

Are you currently smoking?

YesNo

If you quit smoking, how many non-smoking years do you have?

Enter a whole number

Packs per Day Smoked

Years Smoked

Enter a whole number

Pack Years = Packs per Day x Years Smoked

Have you worked with or been exposed to diesel exhaust, asbestos, radioactive ores, or other toxic chemicals?

YesNoI'm not sure

Do you have a personal history of chronic lung disease? Check all that apply.

NoneChronic bronchitisEmphysemaPulmonary fibrosis

Do you have a family history of lung cancer?

YesNoI'm not sure.

Do you have a primary care provider?

YesNo

Kaweah Health would like to reach out to those with the highest risk to make sure they can see a doctor as soon as possible. Is it okay to contact you?

Yes, please contact me.No, do not contact me.

Please verify that you are human.*

Your Risk Assessment Score

Remember to write down your score!

Thank you for taking an important step in learning about your lung health.

Your risk score is {calculation}.

Please remember — this result is not a medical diagnosis. It is only an estimate of your relative risk for lung cancer, based on your smoking history and other personal factors. This tool is meant to help you understand your general risk level and start a conversation with a healthcare professional.

Only a licensed medical provider can evaluate your actual risk and recommend appropriate screenings or next steps.

When you press SUBMIT, you’ll be directed to the Kaweah Health website, where you can learn what your score means and find information about scheduling a consultation or screening.

Your score is private and visible only on this page, so be sure to write it down or save it before clicking SUBMIT.