Genetic Counselling

Your question about your genetic risk

When requesting our advise in assessment of your genetic risk, it is of great importance to provide us with detailed information of the genetic diagnosis in your family members.
After you submit the data below we will send you a detailed questionnaire with additional specific questions.

Your coordinates:

Family Name:

First Name:

Birth Date:

Sex *

Street + No:

Postal Code:

City:

Country:

Tel:

Fax:

E-mail: *	Please retype the email for verification:

Your Question about your genetic risk:

You can describe your question about your genetic risk below. Please clearly indicate whether you or a family member is affected, and whether the diagnosis has been confirmed with genetic tests.

Your Question: *