Forms & Resources

Patient Forms

Family History Form
Medical History Form
Appointment Information
Risk Assessment Form 

Physician Forms

As of October 1st, 2012, the referral process has changed for the Cancer Genetics Risk Assessment Program.  For more information or to refer a patient, please call (317) 338-RISK(7475).  After an appointment is made, please complete and sign our Fax Order Form (see below), and send along with medical records to (317) 583-2436.  Please remember to pre-certify your patient’s genetic counseling visit. 

Fax Order Form
Triaging Patients for Genetic Testing
FAQ for Hereditary Breast/Ovarian Cancer Genetic Testing
Letter of Medical Necessity 

Related Medical Services

Genetic Counseling Session
Registries
Online Risk Assessment 

Resources

National Society of Genetic Counselors
Facing Our Risk of Cancer Empowered