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THE SCREENING IS FREE WHEN COMBINED WITH A GENETIC COUNSELLING APPOINTMENT

SERVICES MAY BE COVERED BY YOUR MEDICAL AID

An administration fee of R 75.00, charged for this service, will be credited to you in full should you make a subsequent booking for a genetic counselling session

The fee is levied for the expert analysis of your cancer risk profile and the provision of your personalised cancer risk report.

Your pdf report will be sent to you within 7 working days for your personal review, after which time you may book a genetic counselling session for further personal assessment and genetic evaluation of your cancer risk report

By completing and submitting the cancer risk profile form below, you consent to your personal data which you provide, to be collected, processed and retained in our database, exclusively for the purpose of providing this service to you. We will never share your personal information for any purposes other than determining your cancer risk profile.

COMPLETE THE FORM WITH AS MUCH INFORMATION AS YOU HAVE AVAILABLE

THE MORE INFORMATION YOU PROVIDE THE MORE PRECISE YOUR RISK REPORT

Lifestyle
Women's Health
Family History
Medical History
Cancer

You have completed the initial basic personal information form and the information you provided will be saved on your cancer risk profile

The next part of the questionaire will take a bit of time to complete - we suggest that you set aside no less than 30 minutes to complete the remaining part of the questionaire as you may need to think about family member details, birth dates, dates of deceased family members, and medical history.

If you are in doubt about dates relating to family members you may provide estimated dates as close as possible to your best estimation. An estimated date is not completely ideal, but it is better than no date.

You will be taken through a 12 step process to provide information required

to calculate your own personal cancer risk profile

 

The information collection process will collect data about some relevant lifestyle factors that have an influence on your personal cancer risk, in addition to your family history and your medical health

1. Lifestyle
2. Womens Health
3. Children
4. Siblings
5. Parents
6. Maternal Aunts
7. Maternal Uncles
8. Maternal Grandparents
9. Paternal Aunts
10. Paternal Uncles
11. Paternal Grandparents
12. Your Medical History

While it is possible to click through the YELLOW TABS above, we recommend that you complete one section at a time, starting with "1. LIFESTYLE" and click on the NEXT button at the bottom of each section to advance to the next section,

until the process is completed in sequence.

Complete the initial form

YOUR BASIC PERSONAL INFORMATION

This is the end of the basic personal information section.

After clicking on the "Continue" button below, you will be taken to the next section of the questionaire, to complete your detailed profile.

 

There are 12 sections to complete in the next section.

Please note that you will be required to LOGIN if you have already registered or to REGISTER if you have not already done so.

1. LIFESTYLE

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YOUR ALCOHOL CONSUMPTION

WHY DO WE ASK FOR THIS INFORMATION ?

The consumption of alcohol plays a role in the development of cancers and our assessment of your personal cancer risk score therfore takes this into account. It is thus important to provide and apply this information to achieve an accurate personal risk analysis


Please complete the following fields accurately, according to your best asessment of your alcoholic drink consumption.

Please note that the questionaire distinguishes between different types of alcoholic beverages.

PLEASE NOTE THAT WE TREAT ALL YOUR INFORMATION WITH CARE AND PRIVACY

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2. WOMEN'S HEALTH

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YOUR MENSTRUATION

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Next

3. CHILDREN

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FAMILY HISTORY (YOUR CHILDREN)

This section of the questionaire will collect information about your biological children.

For the purpose of this process only indicate your birth children born to you  

 

ADD ONE CHILD AT A TIME

Click the "Add Child" button immediately below to add the above child and then add additional children by scrolling up and adding the next child

Add Child

Age, gender

Delete

Age, gender

Delete

Age, gender

Delete

Age, gender

Delete

Age, gender

Delete

Age, gender

Delete
Back
Next

Click "Next" to proceed when you have added all children.

4. SIBLINGS

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YOUR SISTERS & BROTHERS

FAMILY HISTORY (YOUR SIBLINGS)

This section of the questionaire will collect information about your siblings

viz. Your biological brothers and sisters only

viz. Siblings by blood only

 

Click the "Add Sibling" button immediately below to add the above sibling and then add additional siblings by scrolling up and adding the next sibling

Add Sibling

Age, gender

Delete

Age, gender

Delete

Age, gender

Delete

Age, gender

Delete

Age, gender

Delete

Age, gender

Delete
Back
Next

Click "Next" to proceed when you have added all siblings.

5. PARENTS

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FAMILY HISTORY (YOUR PARENTS)

This section of the questionaire will collect information about your parents

NOTE: Your biological (birth) parents only

NOTE: your blood (birth) parents only