Imperial Brown – Cologuard (100% Employer Paid) Employer(required) Imperial Brown Test Requested(required) COLOGUARD Name(required) Email(required) Date of Birth(required) Sex(required) Female Male Last Name of Primary Insured Individual(required) Cologuard - Survey Questions - Check Box If Only Answering YES for Each Question(required) Are you above or approaching the age of 45? Do you have a personal history of conditions associated with high colorectal cancer risk? Do your parents have a history of conditions associated with high colorectal risk? Have you had a colonoscopy within the past 3 years? Do you have hereditary cancer syndrome? Do you currently have symptoms of colorectal cancer such as rectal bleeding or blood in stool? Shipping Address (Please Enter Full Address on One Line: Street, City, State, Zip)(required) Phone Number(required) Submit Δ Share this:TwitterFacebookLike this:Like Loading...
