Get Navigating Breast Cancer Risk

Filling out the Navigating Breast Cancer Risk form is a crucial step in understanding and assessing your risk for breast cancer. This guide provides clear, step-by-step instructions to help you complete the form accurately and with confidence.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by filling in the 'Name of Personal Physician' field. Provide the name of your physician who can assist with your breast health inquiries.
3. Next, indicate your age in the designated age field. This information helps in risk assessment.
4. Select your ethnic identity from the options provided: White, Black, Hispanic, Asian, or Other. This demographic information may assist in understanding risk factors.
5. Answer the question regarding when you had your first menstrual period. Enter your age at that time.
6. Indicate whether you have children by selecting 'Yes' or 'No.' If you answered 'Yes,' provide your age at the time of your first live birth.
7. Respond to the question about any previous diagnosis of invasive breast cancer. If applicable, state the age at which you were diagnosed.
8. Answer whether you have had any other cancers. If 'Yes,' specify the type of cancer and the age at which it was diagnosed.
9. Indicate if you have undergone a breast biopsy. If so, specify how many biopsies you had and the diagnosis from those procedures.
10. Specify the number of first-degree relatives (mother, daughter, sister) diagnosed with breast cancer and identify each relative.
11. Do the same for second-degree relatives (grandmother, aunts) who have had breast cancer.
12. Indicate if you have any relatives diagnosed with male breast cancer.
13. Indicate whether you have relatives with ovarian cancer and provide the relationship if applicable.
14. Review the consent section regarding the evaluation of your breast cancer risk and permissions related to follow-up contacts and database entry. Provide your signature and date.
15. Fill in the contact information fields, including your name, address, city, state, zip code, and your phone numbers. Ensure all information is accurate.
16. Finally, read and acknowledge receipt of Baylor's Notice of Health Information Practices. Sign and date this section as well.
17. Once you have completed the form, save any changes, and you can either download, print, or share the form as needed.

Take the next step in assessing your health by completing the Navigating Breast Cancer Risk form online today.