Person Affected
Mother’s Side
Father’s Side
Have you or any family member had:
Have more than one member on the same side of the family had:

If you answered “yes ? to any of these questions, you may consider further evaluation of your risk of developing a hereditary cancer with a genetic counselor.

CLIA # 11D2084528 11535 Park Woods Circle, Suite E; Alpharetta, GA 30005 1-855-647-4363 www.mygenomics.com MGV104/09-16