Family History Assessment

The tool provides the opportunity to input general information about your family history by answering a series of questions. A report is created based on your responses to the questions. The report provides some general information about common inherited conditions related to your responses and suggests additional medical information a person may need to collect from family members to better understand any inherited conditions in the family. The report may be viewed on-line or printed for your files.The family history assessment questionnaire is separated into two sections:

• Section I: General Family History Assessment provides the opportunity to input general information about your family history.
• Section 2: Reproductive Family Genetic Assessment is designed for those who are pregnant or considering a pregnancy. In this section, it is requested that each member of a couple complete their own questionnaire to determine any familial or exposures of concern to the pregnancy.

NOTE: This tool is not intended to replace any discussion an individual may have with his or her health care provider and does not replace the family history analysis that can be provided by a geneticist or genetic counselor. This tool is intended for educational purposes only and is not intended to serve as medical advice. Always seek the advice of your physician or other qualified health care provider with any questions you may have.

How to Use the Tool
STEP 1: Read through each question and check the box on the right if the question applies to you or your family health history. Use the “Next” and “Previous” buttons to move through all four pages.
STEP 2: Once you have reviewed all questions, click the “Display Report” button to view your customized report.
STEP3: Use the “Next” and “Previous” buttons to view each of the pages in the report. The report can be printed for your files, or to provide to your health care provider on your next office visit.
STEP4: Print Report
Go to the Family History Assessment