Genetic Risk & Family History Assessment
This short pre-assessment helps Kamiloğlu Hospital Health+ understand whether your personal or family health history suggests a need for doctor-led genetic risk assessment, family-history review or a more personalised check-up plan.
It is not a diagnosis and does not replace medical consultation.
What is your main reason for completing this form?
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What is your main reason for completing this form?
Please select any condition that applies to you personally.
Have you personally been diagnosed with any of the following?
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Have you personally been diagnosed with any of the following?
If you had a diagnosis, at what age were you diagnosed?
If you had a diagnosis, at what age were you diagnosed?
Please answer based on your close blood relatives, such as parents, siblings, children, grandparents, aunts, uncles or cousins.
Has anyone in your family been diagnosed with cancer?
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Has anyone in your family been diagnosed with cancer?
Which cancers have occurred in your family?
If Yes: Which cancers have occurred in your family?
Which cancers have occurred in your family?
Which relatives were affected?
If Yes: Which relatives were affected?
Which relatives were affected?
Were several of these cancers seen on the same side of your family?
If Yes: Were most of these cancers seen on the same side of your family?
Were several of these cancers seen on the same side of your family?
Is there a known inherited genetic mutation in your family?
If Yes: Is there a known hereditary genetic mutation in your family?
Is there a known inherited genetic mutation in your family?
If yes, which gene or test result was reported?
For example: BRCA1, BRCA2, Lynch syndrome, APC, MUTYH, FH-related gene, or other reported result.
Cardiovascular and sudden death family history
This section helps identify possible inherited cardiovascular risk signals in the family.
Has anyone in your close family had any of the following?
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Has anyone in your close family had any of the following?
Which relatives were affected by cardiovascular disease or sudden death?
If Yes: If you selected any of the options above, please answer the follow-up questions below. If none apply or you are not sure, you may leave this section blank and continue.
Which relatives were affected by cardiovascular disease or sudden death?
Metabolic and chronic disease family history
This section helps identify family-history signals related to metabolic, endocrine and chronic disease risk.
Has anyone in your close family had any metabolic or chronic disease history?
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Has anyone in your close family had any metabolic or chronic disease history?
Which relatives were affected by metabolic or chronic disease?
If Yes: If you selected any of the options above, please answer the follow-up questions below. If none apply or you are not sure, you may leave this section blank and continue.
Which relatives were affected by metabolic or chronic disease?
Is there anything else you would like our doctor to know?
You may briefly mention any important diagnosis, family history, previous genetic test result or concern that was not covered above.
By submitting this form, you confirm that the information you provide may be reviewed by Kamiloğlu Hospital Health+ for pre-assessment and follow-up guidance. This form is not a diagnosis, does not replace a medical consultation and is not intended for emergency use.
If you have chest pain, severe shortness of breath, fainting, neurological symptoms or any urgent complaint, please seek emergency medical care immediately.
This pre-assessment is based on internationally recognised family-history and risk-assessment principles used in hereditary cancer risk evaluation, cardiovascular risk screening and metabolic risk review. The questions are informed by guidance and clinical criteria commonly referenced by organisations such as the National Comprehensive Cancer Network (NCCN), the American Heart Association / American College of Cardiology (AHA/ACC), the Centers for Disease Control and Prevention (CDC), and the World Health Organization (WHO).
This form does not provide a genetic diagnosis or calculate a definitive disease risk score. It helps identify whether a doctor-led review, genetic risk assessment or personalised check-up pathway may be appropriate.