Pre-consultation: Genetic Testing

First name *

Last name *

Email *

Phone *

Date of birth *

What prompted your interest? (select all that apply) *

Family history of genetic condition

Cancer risk assessment (BRCA1/2, Lynch syndrome)

Pharmacogenomics (medication response)

Carrier testing

Pregnancy planning or fertility

Wellness / Curiosity

Other

Select all that apply:

BRCA1/2 (breast, ovarian, pancreatic cancer)

Lynch syndrome (bowel, endometrial cancer)

Familial hypercholesterolaemia (high cholesterol)

Haemochromatosis (iron overload)

Factor V Leiden (blood clots)

Huntington's disease

Cystic fibrosis (carrier)

Sickle cell or thalassaemia (carrier)

Spinal muscular atrophy

Other - please specify

If 'Other', please describe:

Which relatives have been diagnosed with a genetic condition?

Any relatives who have had genetic testing?

No

Yes

Not sure

Have you had genetic testing before? *

No

Yes

Who ordered the previous test (NHS, private, direct-to-consumer)?

How familiar are you with genetic testing? *

Good understanding

Some knowledge

Very little - want clear explanation

Are you aware that genetic counselling is available before and after testing?

Genetic counselling helps you understand results and implications for family members

Yes

No

Unsure

Emotional readiness for any result (positive or negative): *

Ready for any result

Somewhat anxious about results

Very anxious

Not sure

If anxious, what are your main concerns?

Are you aware that genetic results may have implications for your relatives?

Yes, I've thought about this

No, I hadn't considered it

Unsure

Have you discussed testing with family members?

Yes

No

Partially

Are you aware of UK genetic test insurance protections?

UK has a voluntary moratorium: insurers cannot generally request genetic tests, with limited exceptions (e.g. life insurance >£500k)

Yes

No

Partially

Privacy concerns about genetic data:

No concerns

Minor concerns

Significant concerns

If concerned, what are your main worries?

Are you currently pregnant or planning to become pregnant?

No

Yes - pregnant

Yes - planning

Unsure

Have you had any pregnancy complications or miscarriages?

No

Yes

Ethnicity / ancestry (affects genetic risk profiles):

Any known carriers in your ethnic community? (e.g. Tay-Sachs in Ashkenazi, beta-thalassaemia in Mediterranean)

No

Yes

Not sure

Anything else about genetic testing you'd like to discuss?

Here's what you've told us. Have a quick check, then hit send - this means your consultation can focus on what actually matters to you.

Your details

Name

Email

Phone

Date of birth

Why are you interested in genetic testing?

What prompted your interest? (select all that apply) -

Are you concerned about any specific conditions?

Select all that apply: -

If 'Other', please describe: -

Family History

Which relatives have been diagnosed with a genetic condition? -

Any relatives who have had genetic testing? -

Previous Genetic Testing

Have you had genetic testing before? -

Who ordered the previous test (NHS, private, direct-to-consumer)? -

Your Knowledge & Readiness

How familiar are you with genetic testing? -

Are you aware that genetic counselling is available before and after testing? -

Emotional readiness for any result (positive or negative): -

If anxious, what are your main concerns? -

Family Impact

Are you aware that genetic results may have implications for your relatives? -

Have you discussed testing with family members? -

Insurance & Legal

Are you aware of UK genetic test insurance protections? -

Privacy concerns about genetic data: -

If concerned, what are your main worries? -

Pregnancy & Fertility

Are you currently pregnant or planning to become pregnant? -

Have you had any pregnancy complications or miscarriages? -

Ancestry & Genetic Background

Ethnicity / ancestry (affects genetic risk profiles): -

Any known carriers in your ethnic community? (e.g. Tay-Sachs in Ashkenazi, beta-thalassaemia in Mediterranean) -

Anything else about genetic testing you'd like to discuss? -

Upload previous genetic test results or family medical records

Optional: PDF or image files, max 10MB each

Click to upload files

Anything else for your doctor?