Cologuard 2025

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.(To be contacted by the Center for Healthy Living)

example@example.com

3

Phone Number* This field is required.(To be contacted by the Center for Healthy Living)

Please enter a valid phone number.

4

Which Purdue University campus are you affiliated with?* This field is required.

Purdue Northwest

Purdue West Lafayette

Purdue Fort Wayne

Other

5

Have you had your annual physical?* This field is required.Dated January 1, 2024 - December 31, 2024

Yes

No

6

Have you had a Cologuard screening in the past three (3) years?* This field is required.

Yes

No

7

Have you had a normal or abnormal colonoscopy in the last 10 years?* This field is required.

Yes

No

8

Are you over the age of 45?* This field is required.

Yes

No

9

Are you over the age of 85?* This field is required.

Yes

No

10

Do you have any of the following?* This field is required.(Select all that apply)

A personal history of colorectal cancer or polyps

A family history of colorectal cancer

A personal history of inflammatory bowel disease (ulcerative colitis or Crohn's disease)

A confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC)

None of the above

11

You are not eligible to complete a Cologuard screen at this time based on 1 or more of your answers.

Unfortunately, you are not eligible for Cologuard screening test. Please contact the Center for Healthy Living at 765-494-0111 if you would like more information.