This brief questionnaire will help you learn about whether you should get more information about hereditary cancer from a healthcare provider. On average, the quiz takes less than 1 minute to complete.
Please include information about both your biological mother's and biological father's sides of the family when answering questions. You will be asked about the following cancers/conditions in your family:
These questions are based on established clinical guidelines for referrals to specialized healthcare providers to discuss a personal and/or family history of cancer. A referral will help you learn whether you should have further evaluation (including genetic counseling) and consider genetic testing. This questionnaire will help determine if you may have an increased risk for hereditary cancer, so that you can be more prepared when you talk to your healthcare provider about the possibility of learning more through a referral.