Send Me a FREE Test Kit

Can't make it to Walgreens to get your FREE test kit? Then use the check box below to notify us and we will send you a FREE test kit by mail with a return label. Remeber, return your completed Test Kit by DATE in order to qualify to win a FREE gift courtesy of The Endoscopy Center.

Should we send a FREE Test Kit to the Shipping Address below? *

Yes. Please send me a FREE Test Kit by mail.

No. Do not send me a FREE Test Kit. I will pick one up at Walgreens.

Enter to Win a FREE Colonoscopy!

Personal Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Are you above the age of 40? *

Yes

No

Gender *

Male

Female

Pre-Screening Questionaire

Have you ever had a colonoscopy? *

Yes

No

What is your age?

+-

If Yes, who was your doctor? *

If Yes, how long ago was it done? *