Ovarian Cancer Risk Assessment

Please be aware this program is usually covered by insurance, however, you may be responsible for a copay. If your insurance requires a referral, you will need to obtain one from your doctor.

To determine if this program is appropriate for you please answer a few brief questions.

Please complete the assessment below to determine if this program is appropriate for you. If you are eligible, a referral specialist will contact you within two business days to gather more detailed information.

Contact Information

Are you the patient? *

Have you ever been seen at Roswell Park Cancer Institute?


Has this individual ever been seen at Roswell Park Cancer Institute?

Would you like to join our mailing list?

Patient's Contact Information
Eligibility

Do youDoes the patient have a personal history of ovarian cancer?

Do youDoes the patient have a personal history of breast cancer before the age of 45?

Do youDoes the patient have a family history of any of the following cancers in a 1st or 2nd degree relative (mother, sister or grandmother)?

Have youHas the patient or any blood relative tested positive for BRCA1 or BRCA2?

Have any of yourthe patient's male relatives had breast cancer?

Do youDoes the patient have a family history of hereditary nonpolyposis colorectal cancer (HNPCC) in a 1st or 2nd degree relative (known as Lynch II or positive for EPCAM, MLH1, MSH2, MSH6, PMS2)

In the past month, have youhas the patient had one or more of these symptoms daily for at least 2 weeks?