Patient Forms

Family History Questionnaires:

 

We ask for you to fill out the forms to the best of your ability. The questionnaire will ask you about yourself and your family structure and it is important to include information for all family members (affected and unaffected) asked about in the questionnaire.

Consent to Release Information forms 

Consent to Release Forms are used to gain consent from affect relatives with a particular diagnosis (i.e. cancer) or their next of kin to confirm the diagnoses in the family. We ask for you to please pass these out and ask the appropriate relatives to fill them in to the best of their knowledge, and then return them to the genetic service.

 

If your family members are overseas we would recommend they fill out a consent form. Alternatively, you could try to obtain clinical letters and/or histology reports from your relatives.

 

Confirmations of diagnoses are important to our risk assessment and can alter any advice or recommendations we give to you.

© 2017 Genetic Health Service NZ.  Disclaimer

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