Should You Be Tested?

1. I'm planning to have children:

Yes No Already pregnant

2. My ethnic background is primarily:
(check all that apply)

Ashkenazi Jewish Irish British French Canadian Cajun African American Asian African Mediterranean Other Don't know

3. My family health history includes the following:
(Consider immediate family, grandparents, aunts, uncles, and first cousins. Check all that apply.)

Birth defects Mental retardation or developmental delays Genetic disorders Pregnancy loss or stillbirth Miscarriage Problems conceiving Family history of genetic disease Family history of Multifactorial diseases such as Cancer or Diabetes None of the above

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