Request

OCRA Genetic Testing Kit Questionnaire

OCRA's Free Genetic Test Kit Questionnaire
Please allow 10-15 minutes to complete this process, which will consist of 2 steps for those deemed eligible for a free genetic test kit, and 1 step for those who do not qualify.

Complete the brief questionnaire below to determine your eligibility. If you are deemed eligible, you will be given a one-time code for an application to provide further information. If you have any questions throughout the process please email OCRA at info@ocrahope.org

Please note that this questionnaire is not a risk assessment tool.

Screening Questionnaire

* Why are you seeking a genetic test?

This question is strictly for demographic purposes and has no bearing on your eligibilty for a genetic test.

I was diagnosed with cancer

I have a family history of ovarian cancer

I have a family history of other gynecological cancers

I have a family history of other cancers that increase risk for ovarian cancer

I have a family history of genetic mutations that increase my risk

I do not know my family history and want to know my risk

Other

* First Name

* Last Name

* Email

Providing this information will not result in being added to any email lists.

* Are you 18 or older?

Yes

* Do you currently live in the US?

Yes

* Have you previously undergone genetic testing for inherited cancer risk?

Yes

Unsure

* Have you been diagnosed with ovarian, breast, uterine, or colorectal cancer?

Yes

* Do you have a family history* of ovarian, breast (onset before age 45), uterine, or colorectal cancer?

*Blood relative: parent, child, sibling, grandparent, aunt/uncle

Yes

Unsure

* Would you like to receive updates on OCRA efforts including events, resources, new programs, and research news?

Yes

* If you do not qualify for a free test would you like OCRA to contact you if the program expands?

While you may not qualify because of age, location, or because you are unsure of your family history and unable to get this information, OCRA's free genetic testing program requirements may change in the future.

Would you like to receive an email if additional test kits become available?

Yes

* How did you hear about OCRA's Genetic Testing Program?