Colorectal Cancer Screening – Free At-Home Test Kit

Colorectal cancer is the third leading cause of cancer-related deaths in the United States. Although it is one of the deadliest forms of cancer, it can be cured if caught early. Preventive screenings are the key to early detection.

A fecal immunochemical test (FIT) is a method of screening for colorectal cancer by detecting blood in your stool. You will not have to change your diet, fast, or make changes to your medications before completing the test. You will mail your sample to the processing lab in the prepaid return envelope provided. The lab will send you your results directly.

If your health plan offers this program, you may participate if you meet the following criteria.

You are between the ages of 45 and 75
You have not had a sigmoidoscopy in the last 5 years, a colonoscopy in the last 10 years, or a FIT screening in the last 12 months
You are covered by your medical plan on the last day of the month your request is submitted

If you meet the requirements and are interested in participating, please verify with your health plan administrator that this program is available to you. You may then complete and submit the following form or contact our Wellness Department.

View the program details.

Request to Enroll

Prior to submitting this request, please review the eligibility requirements and verify with your health plan administrator that this program is available to you. We will respond with next steps via email.

Note: Program information and requirements will be sent to you via email. In some cases, emails may be found in your “junk” email folder. If you do not see our email within 2 business days of submitting your request, please contact us at HWMGwellness@hwmg.org.

Name*
First Last
Plan Member ID #*
Date of Birth*
MM slash DD slash YYYY
Phone*
Email*
Mailing Address*
Street Address City State ZIP Code
Primary Care Physician*
Date of Last Colorectal Cancer Screening
MM slash DD slash YYYY
Response Preference*
Communication Method
Select Response*
Time of Day
Eligibility Requirements*
To be eligible, you must be between the ages of 45 and 75, not had a sigmoidoscopy in the last 5 years, a colonoscopy in the last 10 years, or a FIT screening in the last 12 months; and covered by a participating medical plan during the month of your request.
- I have read the eligibility requirements and understand that submitting this request does not constitute program enrollment.
Email
This field is for validation purposes and should be left unchanged.