The information you provide in this section will help you receive better guidance from our Genetic counsellors and will enable us to make your truGeny test report more informative and personalised.

All the information you provide is kept confidential and secure. So go ahead and fill in the information to the best extent you can.

General wellness

This information you provide will be used to assess your risk of developing a cardiovascular disease (including heart attack, stroke, heart failure, and others)

What is your date of birth ?

How tall are you?

How much do you weigh?

Your most recent blood pressure reading

/

Do you currently:

Smoke cigarettes
Drink alcohol
Have diabetes
Take medication to treat high blood pressure

Medications

We encourage you to share information about your current prescriptions.
You can upload

Are you currently taking any medications?

Please list all current prescription medications.

Have you had a liver transplant?

Are you currently seeing a doctor to be diagnosed or treated for a kidney or liver problem?


Your cancer health history

Have you had (or do you currently have) cancer?

Have you ever had colon polyps identified on colonoscopy or sigmoidoscopy? Optional

Approximately how many polyps have been found on colonoscopy or sigmoidoscopy in your lifetime?

Have you ever had:

Bone marrow transplant or blood transfusion

Was the transplanted bone marrow your own?

Have you had a blood transfusion in the week before providing your truGeny sample?

Have you had a genetic test for hereditary cancer risk?

Who performed the genetic test?

Was a mutation identified?


Your heart health history

Have you ever been diagnosed with:

Familial hypercholesterolemia(FH)  Optional

How old were you?

Cardiomyopathy  Optional

How old were you?

How old were you?

Hereditary arrhythmia or conduction disorder  Optional

How old were you?

How old were you?

Arteriopathy/connective tissue disorder   Optional

Heart failure Optional

How old were you?


Enlarged heart (cardiomegaly)

How old were you?


Have you ever experienced:

Heart attack Optional

How old were you?

Sudden cardiac arrest Optional

How old were you?

Stroke Optional

How old were you?


Enlargement of an artery (aneurysm) Optional

How old were you?

Where was your aneurysm located?


Tear of an artery (dissection) Optional

How old were you?

Where was your aneurysm located?


Fainting or passing outafter exercise Optional


Irregular heartbeat (arrhythmia) Optional

How old were you?


What type of irregular heartbeat (arrhythmia) did your healtcare provider diagnose you with?


Heart or vascular surgery Optional

Type of surgery (check all that apply):


Have you ever been told that you have high cholesterol?


Have you ever been told you have:

Cholesterol deposits on your eyeliids or in your tendons

A white ring around your iris (corneal arcus) Optional

How old were you?


Have you ever had a genetic test for hereditary heart conditions? Optional

Who performed the genetic test?

Was a mutation identified?


Knowing your family health is very important to assess your risks for certain diseases.

The first step is to build your family tree. Dont't worry if you dont know all the answers.You can always take the help of your relatives.


Do you have any children?

How many biological daughters do you have?

First daghter’s name (optional)

First daghter’s age:

How many biological Sons do you have?

First Son's name (optional)

First son’s age:)


Do you have any siblings?

How many sisters do you have?

First sister’s name (optional)

First sister’s age:

How many brothers do you have?

First brother’s name (optional)

First brother’s age:


Tell us about your parents and grandparents.

Estimates are okay.

Mother's name (optional):

Mother's age:


Father's name (optional):

Father's age:


Maternal Grandmother's name (optional):

Maternal Grandmother's age:


Maternal Grandfather's name (optional):

Maternal Grandfather's age:


Paternal Grandmother's name (optional):

Paternal Grandmother's age:


Paternal Grandfather's name (optional):

Paternal Grandfather's age:


What is the ancestry of your grandparents? Please enter the countries of your grandparents' ancestors, not the country they were born in. (check all that apply)

In what country were you born? Optional

Option


Does your mother have any siblings? Optional

How many sisters does he have?

How many brothers does she have?


Does your father have any siblings?

How many sisters does he have?

How many brothers does he have?


Your Family Health History

The record of your family health history will enable us to better understand, interpret and personalise your reports. If your are uncertain about some of the questions please make your best estimation.

Your family's cancer history

Has anyone in your family had cancer?

Has anyone had a genetic test for hereditary cancer risk?

Who performed the genetic test?

Was a mutation identified?

Who performed the genetic test?

Was a mutation identified?

Who performed the genetic test?

Was a mutation identified?


Your family's heart health history

Has anyone in your family been diagnosed with:

Familial hypercholesterolemia(FH) Optional


Cardiomyopathy


Hereditary arrhythmia or conduction disorder


Arteriopathy/connective tissue disorder


Heart failure

How old was he?

How old was he?

How old was she?

How old was he?

How old was she?

How old was he?


Enlarged heart (cardiomegaly)


Has anyone in your family experienced:

Sudden cardiac arrest or sudden death Optional

How old was she?

How old was he?

How old was she?

How old was he?

How old was she?

How old was he?


Heart attack Optional

How old was he?

How old was she?

How old was he?

How old was she?

How old was he?

How old was she?

How old was he?


Stroke Optional

How old was she?

How old was he?

How old was she?

How old was he?

How old was she?

How old was he?


Enlargement of an artery (aneurysm) Optional

How old was she?

How old was he?

How old was she?

How old was he?

How old was she?

How old was he?


Tear of an artery (dissection) Optional

How old was she?

How old was he?

How old was she?

How old was he?

How old was she?

How old was he?


Fainting or passing out after exercise


Heart or vascular surgery Optional

Irregular heartbeat (arrhythmia) Optional


Cholesterol deposits on their eyelids or in their tendons Optional

A white ring around their iris (corneal arcus) Optional


Diabetes


Has anyone in your family had a genetic test for hereditary heart conditions?


Is there anything else related to your personal or family history that you would like to share?


Health History

Complete


Family Tree

Created


Family Health History

Incomplete


Health Records Uploaded

One File

Your Family Tree

Card image cap

Parental Grandfather

Age 98, deceased

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Parental Grandmother

Age 98, deceased

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Kannam Raju

Age 98, deceased

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Lakhsmi j

Age 98, deceased


Name

Relationship

Age

Name

Relationship

Age

Card image cap

Parental Grandmother

Age 98, deceased

Card image cap

Parental Grandmother

Age 98, deceased


Name

Relationship

Age

Name

Relationship

Age

Name

Relationship

Age

Card image cap

Parental Grandmother

Age 98, deceased

Name

Relationship

Age

Name

Relationship

Age

Name

Relationship

Age

Name

Relationship

Age