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Personal and Family History Questionnaire for Hereditary Cancer 2026

The document is a Personal and Family History Questionnaire designed for hereditary cancer risk assessment. It collects information about the patient's personal and family history of various cancers, including breast, ovarian, colorectal, and Lynch-associated cancers. The questionnaire aims to identify potential hereditary cancer risks by documenting diagnoses within the family, genetic testing history, and adherence to specific guidelines for further genetic testing recommendations.

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Click ‘Get Form’ to open it in the editor.
Begin by entering today's date, your name, date of birth, and age at the top of the form. This information is crucial for accurate assessment.
In the personal and family history section, mark 'Yes' or 'No' for any personal or family history of cancer. Be sure to indicate the relationship and age at diagnosis in the provided columns.
List each family member separately, including parents, siblings, grandparents, aunts, uncles, nieces, and nephews. This detailed information helps healthcare providers understand your risk better.
For specific cancers mentioned in the questionnaire, check 'Yes' or 'No' based on your family's medical history. Pay close attention to age-related criteria as they are significant for risk assessment.
If applicable, answer questions regarding genetic testing results by indicating who was tested and when. This information can guide further recommendations.

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Is Ambry Genetics legitimate?

Since 1999, Ambry Genetics has provided clinicians with accurate, affordable, and medically actionable genomic information so that they can make informed medical management decisions with their patients. Everything we do is backed by our science, and we have always believed in evidence-based medicine, backed by data.

What is the Ambry genetics questionnaire?

Instructions: This is a screening tool to help your healthcare provider determine if you would benefit from hereditary cancer genetic testing.

How much does an Ambry Genetics test cost?

Ambry Genetics Corporation Cash price for genetic testing is $249 with two-year, zero percent repayment plans available.

What is the genetic test for hereditary cancer?

Genetic testing of the blood or saliva can be used to identify whether someone has an inherited harmful genetic change in one of these genes. Genetic testing for inherited cancer risk is different from genetic testing of tumors, which is sometimes used to guide treatment.

What cancers does Ambry Genetics test for?

Comprehensive Testing Guideline-based, pan-cancer test that covers the most common hereditary cancer types, including hereditary , ovarian, pancreatic, prostate, colorectal/polyps, endometrial, gastric, small , urothelial, and renal cancers.