PROACT LUNG PRE-ENROLLMENT

Date and time

Birthday

I am

Are you a smoker*

Do you have a history of any malignancy within prior 5 years .

Received a blood transfusion in the 30 days preceding enrollment.

History of organ, tissue, and bone marrow transplantation.

Have had a CT Scan of your chest in the last 12 months. (X-rays are not included)

Have you participated or currently participating in another Freenome-sponsored clinical study.

Participated or currently participating in a clinical research study in which an experimental medication has been administered during the 60 days preceding enrollment.

ARE YOU PREGNANT

I own a smartphone