Common Problems | Colorectal Problems | Other GI Problems

Common Colorectal Problems

FAMILY HISTORY QUESTIONAIRE FOR RISK OF HEREDITARY COLON CANCER

Are You at Risk for Cancer?

Genetic testing and advances in knowledge have demonstrated a family tendency to develop COLORECTAL CANCER. Are you in that category? Is your risk higher? The form provided will help us determine if you need further assessment.

Please check the boxes below for yourself and for each family member who has had cancer as indicated. Questions marked by an asterisk (*) must be completed in order to submit form.

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