In the questionnaire below, please check all that apply and calculate the numbers in parentheses. If your score is 2 or greater you may be eligible for genetic counseling and possible genetic testing for a hereditary cancer syndrome.
Have you ever had any of the cancers or medical history?
Have any of your relatives had any of the following cancers?
If you totaled 2 or more, please check this box, fill out the form below & submit.
Mailing Zip/Postal Code