Ductal Adenocarcinoma – Pancreatic Health Check
Notify
First Name
Last Name
Patient Email
Patient Phone
Has anyone in your immediate family been diagnosed with pancreatic cancer?
Yes
No
Have you had new or unexplained upper stomach and/or back discomfort for more than a few weeks?
Yes
No
Have you experienced unintentional weight loss or a drop in appetite?
Yes
No
Have you recently developed diabetes or noticed sudden changes in blood sugar?
Yes
No
Have you seen pale stools or darker-than-normal urine?
Yes
No
Do you currently smoke or have a long history of smoking?
Yes
No
Additional Information
Submit
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