Female Questionnaire
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There are risk factors associated with certain conditions that your relatives may have had: if you know of any, please tell us here.

NOTE: 'Close' relatives are brothers, sisters, parents or grandparents.

Q988

Allergies in close family members?

None / don't know
Minor in one parent
Minor in two parents or significant in one
Significant in two parents
Severe in two parents

Q989

Alzheimer's Disease in close family members?

None / don't know
Probably in one family member
Probably in more than one family member
Yes, in one family member
Yes, in more than one family member

Q990

Cancer of ANY type in close family members?

None / don't know
Probably, one family member
Probably, more than one family member
Yes, one family member
Yes, more than one family member

Q991

Melanoma (a dangerous form of skin cancer) in close family members?

None / don't know
Probably, in one parent or sibling
Probably, in two or more parents or siblings
Yes, in one parent or sibling
Yes, in more than one parent or sibling

Q992

Cancer of the colon / rectum in close family members?

None / don't know
Probably, in parent(s) or sibling(s)
Yes, in one parent or sibling
Yes, in more than one parent or sibling

Q993

If your mother ever had Breast Cancer, at approximately what age did she get it?

Q994

Has there been Breast Cancer in any other close family member besides your mother?

None / don't know
Perhaps, in one family member
Perhaps, in more than one family member
Yes, in one family member
Yes, in more than one family member

Q995

Has your mother or a sister had Cervical Cancer?

Q996

Chronic Fatigue in close family members?

None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one family member
Yes, in more than one family member

Q997

Colitis (inflammation of the colon) or Ulcerative Colitis in close family members?

None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one family member
Yes, in more than one family member

Q998

Depression in close family members?

None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one family member
Yes, in more than one family member

Q999

Diabetes in either distant or close relatives?

None / don't know
Yes, in a distant relative
Yes, in 1 direct or 2 distant relatives
Yes, in 2 direct relatives
Yes, in more than 2 direct relatives

Q1000

If your father ever suffered Heart Attack(s), at approximately what age did they start?

Q1001

If your mother ever suffered Heart Attack(s), at approximately what age did they start?

Q1002

Aside from Heart Attacks, has there been any heart disease in close family members?

None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one family member
Yes, in more than one family member

Q1003

Did either of your parents suffer from Hypertension?

None / don't know
Mild in one parent
Both parents mild or one parent moderate
Both parents moderate or one parent high
Both parents high or one parent severe

Q1004

Hyperthyroidism in close family members?

None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one family member
Yes, in more than one family member

Q1005

Hypothyroidism in close family members?

None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one family member
Yes, in more than one family member

Q1006

Kidney Stones in close family members?

None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one family member
Yes, in more than one family member

Q1007

Glaucoma in close family members?

None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one family member
Yes, in more than one family member

Q1008

Macular Degeneration (any type) in close family members?

None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one family member
Yes, in more than one family member

Q1009

Muscle pains in close family members?

None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one family member
Yes, in more than one family member

Q1010

Schizophrenia in close family members?

None / don't know
Yes, in one distant relative
Yes, in one direct relative or 2 distant relatives
Yes, in 2 direct relatives
Yes, in more than 2 direct relatives

Q1011

Stroke in close family members?

None / don't know
Yes, in one distant relative
Yes, in more than one distant relative
Yes, in one direct relative
Yes, in more than one direct relative

Q1012

Tuberculosis in family members that you live with?

None / don't know
Probably, in one family member
Probably, in more than one family member
Yes, in one or more family members
Yes, in more than one generation of family members