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:

  • Ages 50 to 77 years old
  • Be a smoker, or a person who quit smoking less than 15 years ago
  • Have a smoking history of at least 30 pack years
  • Have no new symptoms that could be related to lung cancer
  • Be healthy enough to tolerate treatment intended to cure early-stage lung cancer
  • Have not had a chest CT in the last 12 months

Refer a Patient