Consultation Questionnaire

Is a Genetic Consultation Right for You?

A consultation with a genetic counselor can help assess your cancer risk. If you answer “yes” to any of the following questions, we encourage you to schedule an appointment with us by calling 818-748-4748 or emailing ProvidenceGenetics.CA@providence.org

In the questions below, “family members” include any first-degree (mother, father, siblings, children), second-degree (aunts/uncles, grandparents, nieces/nephews) and third-degree relatives (cousins, great-aunts/uncles, grandchildren).

  • Have you or any of your family members been diagnosed with breast, colon, prostate or uterine cancer before age 50?
Yes No
  • Have you or any of your family members developed a rare type of cancer, such as ovarian, male breast, pancreatic, endocrine, or a sarcoma?
Yes No
  • Have you or any of your family members had numerous colon polyps?
Yes No
  • Have you or any of your family members had more than one type of cancer or bilateral cancers (ex. breast and colon cancer, or breast cancer in both breasts)?
Yes No
  • Have multiple family members been diagnosed with cancer of any type?
Yes No
  • Do you have Ashkenazi (Eastern European) Jewish ancestry? If so, have you or any of your family members had breast, ovarian, pancreatic or prostate cancer at any age?
Yes No
  • Have you or any of your family members had highly aggressive or metastatic prostate cancer?
Yes No

If you are adopted, do not have complete information about your family history, or do not meet any of the above criteria, there are still available options for genetic testing if you are still interested in learning about cancer risks for you and/or your family. Please call us at 818-748-4748 if you have questions about your risk for cancer. You may also use our online form to schedule a consultation.

Schedule a consultation

What to Expect at a Genetic Consultation

Before your appointment, you will complete questionnaires about your medical history and the medical history of your family, regardless of which disease concerns you. In some cases, medical records will be required. Your risk assessment will be based on a number of factors, including the information you provide.

During your visit, we will:

  • Document your personal and family medical history, and construct your medical family tree
  • Discuss your risk of developing cancer and other medical conditions based on your personal and family medical history, a physical exam, and data such as risk models
  • Offer genetic testing if your history suggests a hereditary cancer syndrome. Testing is done through a blood or saliva sample. If you undergo testing, we will speak again in a few weeks to discuss the results in detail.
  • Develop a risk reduction plan tailored specifically to meet your risk needs
  • Discuss important issues, such as who else in your family may benefit from this information

Understanding Genetic Testing Results

Having a genetics consultation will help you understand the actual cancer risks you face. If testing reveals that you are at high risk, our team will explain your options for reducing your risk of cancer and detecting cancer early. If results show you are not are at high risk of hereditary cancer, you can have some peace of mind.

Genetic information helps us:

  • Determine if you have an increased risk of developing certain types of cancer
  • Determine if your family members may have an increased risk of developing certain types of cancer
  • Create a personal risk reduction plan, which may include enhanced screenings, specific lifestyle and wellness programs, medications, and surgery options
  • Develop treatment plans specifically for you (if you have already been diagnosed with cancer) and identify additional cancer risks that you may face