To refer a patient to the Lung Cancer Screening Program at Cleveland Clinic, please complete the following form. If you have any questions, please call the Lung Cancer Screening Program at 216.445.3800.

Patients must meet all the following criteria to be eligible for the screening.

  • Have a 30 pack year history of smoking (cigarettes only)
  • Ages 55-77
  • Have smoked within the past 15 years
  • Have no signs or symptoms of cancer
  • Healthy enough and willing to undergo curative intent treatment