SurveyMonkey Powered Online Survey

Exploring Your Risks For Hereditary Cancers

We have all had our lives touched by cancer, but knowing if you are personally at increased risk can be tricky to figure out. This survey is one way you can begin to understand if your family history indicates increased risks and whether genetic testing would be beneficial.

Take the brief survey below and we’ll contact you in order to help you learn more about your risk for cancer.

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* 1. Have you mapped your family's health history back one or two generations?

Yes, I've researched my family's health and have the information available.

I'm not sure how accurate my family's health information is but I'll do the best I can.

No, I haven't been able to do the research, so I'll be using my best recollections.

Other (please specify)

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* 2. Are you located in the United States?

Yes

Other (please specify)

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* 3. Are you of Ashkenazi Jewish descent?

Yes

I don't know

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* 4. Have you been tested for gene changes?

Yes, I have been. I'll list the gene changes identified below.

No, I've never had genetic tests before.

Other (please specify)

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* 5. What is the email address you would like to for the survey results be sent to?

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* 6. Has your mother or father been diagnosed with cancer? Only 'blood' relatives need to be considered for the survey.

Yes, my mother was diagnosed with cancer. I'll enter her age at diagnosis and type of cancer below.

Yes, my father was diagnosed with cancer. I'll enter his age at diagnosis and type of cancer below.

I don't know or remember.

My mother and father have never been diagnosed with cancer.

Age at diagnosis & type of cancer:

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* 7. Were your mother's parents ever diagnosed with cancer? Only 'blood' relatives need to be considered for the survey.

Yes, my grandmother was diagnosed with cancer. I'll enter her age at diagnosis and type of cancer below.

I don't know or remember.

Yes, my grandfather was diagnosed with cancer. I'll enter his age at diagnosis and type of cancer below.

My grandmother and grandfather have never been diagnosed with cancer.

Age at diagnosis & type of cancer:

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* 8. Were your father's parents ever diagnosed with cancer? Only 'blood' relatives need to be considered for the survey.

Yes, my grandmother was diagnosed with cancer. I'll enter her age at diagnosis and type of cancer below.

Yes, my grandfather was diagnosed with cancer. I'll enter his age at diagnosis and type of cancer below.

I don't know or remember.

My grandmother and grandfather have never been diagnosed with cancer.

Age at diagnosis & type of cancer:

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* 9. For some of our recommendations, we'll need to know where in the world you are. So, please share your zipcode.

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* 10. Were your parents' brothers and sisters ever diagnosed with cancer? Only 'blood' relatives need to be considered for the survey.

I don't know or remember.

Yes, my aunt(s) were diagnosed with cancer. I'll enter their age at diagnosis and type of cancer below.

Yes, my uncle(s) were diagnosed with cancer. I'll enter his age at diagnosis and type of cancer below.

My aunt(s) and uncle(s) have never been diagnosed with cancer.

Age at diagnosis & type of cancer: