Si Paradigm

1) Date of birth?

Please choose date of birth

You are Under Age(Age limit is >=18)

2) Gender at birth?

Please choose answer


3) Are you Adopted?

Please choose answer

4) What is your ethnicity? Select all that apply

Please choose answer

The Ethnicity you've entered already exists in the provided options.

Please write here!

Length should not be greater than 100 characters

Please select Yes or No

5.1) Who

Please choose AlphaNumeric. Character Count should not be greater than 100

5.2) Which gene(s) is positive?

Please choose answer

Please write here!

length should not be greater than 100 characters

If No, please continue

6.1.1) What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

6.1.2) Age at Diagnosis?

Please choose answer

6.2.1) What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

6.2.2) Youngest Age at Diagnosis?

Please choose answer

7.1) Who?

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

What type of cancer?

Please choose answer

The cancer type you've entered already exists in the provided options.

Youngest Age at Diagnosis?

Please choose answer

8) Do you have any colon polyps?

Please choose answer

(Please provide a copy of pathology report)



(Optional)

Please provide a copy of pathology report

File size should not be greater then 20 MB

PDF, Doc/Docx, JPG & PNG files are acceptable only

8.1) What Type

Please choose Polyps Type


Personal Information

Date of Birth?
Gender at Birth?
Are you adopted?
What is your ethnicity?

Personal and Family History

Have you or any of your relative diagnosed had genetic testing previously?
Who?

Which gene(s)?

History of Genetic Mutations

Have you ever been diagnosed with cancer?
What type of cancer?
Youngest Age at Diagnosis?
Do you have another cancer?
What type of cancer?
Youngest Age at Diagnosis?
Has any of your relatives diagnosed with cancer?

First-degree

Parents

Siblings

Children

Paternal second-degree

Grandparents

Aunts

Uncles

Nieces

Nephews

Grand Children

Half-Siblings

Maternal second-degree

Grandparents(2-2)

Aunts

Uncles

Nieces

Nephews

Grand Children

Half-Siblings

Paternal third-degree

Great Grandparents(4-4)

Great Aunts

Great Uncles

First Cousins

Half Aunts

Half Uncles

Maternal third-degree

Great Grandparents(4-4)

Great Aunts

Great Uncles

First Cousins

Half Aunts

Half Uncles

Do you have any Colon Polyps
What type?
How many?

If you want to view or download pathology report, click on download

Download

If you want to view or download pathology report, click on download

Download

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Results

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