Gastroenterology High-Risk Questionnaire
Complete our questionnaire to see if you meet the criteria to request an appointment.
1. Do you have multiple family members with colorectal cancer?
2. Do you have multiple family members with pancreatic cancer?
3. Do you or a parent, child, or sibling have a genetic mutation associated with pancreatic cancer (i.e. BRCA 1, BRCA 2, ATM, PALB 2, CDKN2A) or other?
4. Do you or a parent, child, or sibling have a genetic mutation associated with colorectal cancer (i.e. Lynch Syndrome or Familial Adenomatous Polyposis) or other?
5. Do you or a parent, child, or sibling have a genetic mutation associated with gastric cancer (e.g. CDH1) or other?
6. Do you have a personal history of more than 10 colorectal polyps?
7. Were you diagnosed with a GI Cancer under the age of 50?
You appear to meet guidelines for
Gastroenterology High Risk Cancer Clinic.
Based on the information provided, you may be a candidate.
or call us at 305-689-RISK(7475)
Based on this information, you do not meet the criteria for the Gastroenterology High Risk Cancer Clinic at this time.
Please address any concerns you may have with your primary care provider.
