Full Name Email Gender Male Female Age Phone Number Any current illness been managed? Any chronic disease been managed in the past? Do you or did anyone in your family have long-term health problems like heart disease, diabetes, kidney disease, bleeding disorder or lung disease? Does anyone in your family have any other serious illnesses, such as cancer, stroke, Alzheimer's/dementia, genetic birth disorder, or osteoporosis? Do you or did anyone in your family have any health issues like high blood pressure, high cholesterol, or asthma? SUBMIT Kindly note that family's health history can help your doctor choose the screening tests that might be right for you.