Sarasota Memorial Health Care System : Sign Up to Stay in Touch

The quiz is in 2 sections - A: Your cancer or medical history & B: Your relative's cancer or medical history. Answer each question "Yes" or "No". For each "Yes", add the numbers in parentheses. Enter the final number in the "Total" field. Click "Sign Up" to submit your results and one of our team members will be in touch.

* Email Address

* First Name

* Last Name

* Phone Number

* A: Ashkenazi Jewish Heritage? (1)

* A: Breast Cancer age 45 or below? (2)

* A: Breast/Colon Cancer at any age? (1)

* A: Colon/Uterine Cancer age 50 or younger? (2)

* A: Male Breast Cancer? (2)

* A: Ovarian/Fallopian Tube Cancer? (2)

* A: Pancreatic/Prostate Cancer at any age? (1)

* B: Relatives (2+): Breast Cancer before 50? (2)

* B: Relatives (2+): Colon Cancer before 50?(2)

* B: Relatives (2+): Uterine Cancer before 50? (2)

* B: Relatives: Male Breast Cancer? (2)

* B: Relatives: Ovarian/Fallopian Tube Cancer? (2)

* Total:

Fill out the questionnaire to find out if you qualify for genetic testing.