VCU Massey Cancer Center

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Request an appointment / Refer a patient

This form is for patients to use in requesting an appointment at Massey's Lung Cancer Screening Clinic and for physicians to use to refer a patient.

If you would prefer to speak with our team, please call us at 804-827-LUNG (5864).

To help us help you, please fill in all relevant fields. When you are finished, please click the “Submit” button at the bottom of the form to send your request. We will contact you within one business day of receipt. Thank you.

Information about person sending this form

Information about the patient

Gender

Information about the referring physician (if applicable)

Information about patient's primary care physician