The next step is to fill out our medical questionnaire. You can either do this now, or you may return to complete this at a later date. We will e-mail you a link to this form so you can return any time.
Tick here if you have medical insurance
What was your natural hair colour at the age of 15? *
How many raised moles you have in total on both arms *
Before the age of 20, which of the following best describes how many freckles you had on your arms? *
Previous skin check *
Previous melanoma *
Previous skin cancer *
>Where on the body
As a child up to the age of 18, how many sunburns did you have that were so severe they produced blisters or pain lasting two or more days? *
Family history of skin cancer/melanoma *
Special requirements (e.g. Wheelchair access)
Please be aware that clinical information, including clinical photographs (obtained by SkinHealth UK) will be stored by SkinHealth UK (or services SkinHealth UK may refer the client to). SkinHealth UK may also use information in an anonymised way for educational, commercial or clinical publications. All abnormal results will be copied to your GP, if GP details have been provided, and SkinHealth will follow-up the results of any abnormal screening test to verify the outcome
By signing up to a Cancer Check you agree to the following:
Click here to view our cancellation policy
- I do not have symptoms
- I understand the pros and cons of screening.
- I understand that for some Cancer Checks I may have to undress.
- I agree for Check4Cancer to share my data (name, address and DOB) with the National Disease Registration Service.This government agency, run by Public Health England, registers all cancer diagnosed in England and can provide Check4Cancer with the effectiveness of our early cancer detection services.
- I understand that no cancer detection programme will pick up all cancers. Although early detection programmes are designed to detect cancers that are at an early stage, this may not always be the case. Furthermore, there may be a cancer present despite a normal test.