Forms and Handouts

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Forms and Handouts

 

For New Patients

For Existing Patients

For Prospective Patients

 

For new patients:

Introductory Letter
We send this introductory letter out to our new patients ahead of their appointments.

 

FRAP Program Components
This document provides a brief overview of the various parts of a FRAP evaluation.

 

Health History Questionnaire (pen-and paper version – print, then write in your answers)

Health History Questionnaire (electronic version – complete on your PC, then print & sign)

Please complete this form and bring it with you to your first appointment with the Family Risk Assessment Program.  The health history information and family history information that you provide will help us to more accurately assess your risk for cancer and make personalized recommendations for you.

 

For existing patients:

Release of Findings to Physicians

This form gives us permission to release your test results and other FRAP records (such as your final summary letter with screening recommendations) to the physicians you list.  If you were already evaluated by our program and would like to change that list, you may send us an updated form at any time.

 

Consent for Release of Germline Genetic Test Results and Family History (Pedigree)

This form gives us permission to share your genetic test results and/or family history information with your family members if they reach out to us with questions or to request an appointment. The information obtained during the cancer risk assessment process can frequently benefit other family members who are also learning about their cancer risks.

 

Authorization for Release of Medical Records
If you would like us to request copies of your medical records from another office or facility, please complete this form and send it back to us.

 

For prospective patients:

Family History Questionnaire

This quick survey is designed to identify people who may benefit from an evaluation with the Family Risk Assessment Program.  If you answer “yes” to any of these questions, we recommend that you call to speak with a staff member about a possible appointment.

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