Screening · About 4 minutes

Age-appropriate preventive-health screening

A review of which preventive services may be recommended for your age group and risk profile.

About you

Full name*

Date of birth*

Telephone

Please give at least a telephone number or an email address so the office can reach you.

About you

Which best describes the patient?*

Ongoing conditions that affect preventive care

Screenings already completed

Colon cancer screening, if applicable — type and date

Mammogram, if applicable — date

Cervical cancer screening, if applicable — date

Bone density testing, if applicable — date

Last vision and dental visits

Other preventive services completed elsewhere (optional)

Questions

Preventive services you would like to discuss (optional)

Submitting sends your answers directly to K. Johns Medical over an encrypted connection and creates a PDF for your clinician. It does not book an appointment and is not monitored in real time. For an urgent concern, call the office. In an emergency, call 911 or call or text 988.

Age-appropriate preventive-health screening

Other screenings