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Medical History/Preventative Update

Please List Approximate Date of Last Proceedure

Females age 40-75 (Every two years or more frequently if recommended by your physician)
Females ages 20-65 (Frequency every 1-5 years depending on physician recommendation)<br/>
All individuals over age 50 -75 or other high risk individuals identified by your physician. Frequency is every 1,3 ,5 or 10 years based on the results and your risk factors<br/>
All individuals over 65 or older or other individuals identified as high risk by a physician should receive the vaccine
Male 65-75 that has smoked more than 100 cigs in lifetime
Female > 50 or Male or Female identified by your physician at high risk
* Required field