Genetic Testing Consent

Have you discussed this test with a genetic counsellor or another genetics professional?

Choose one:

• Yes
• No

How well do you understand each of the following?

• Why the test is being offered
• The kinds of result it can give, including unclear results
• What a result could mean for your blood relatives
• What the test cannot tell you
• Possible effects on insurance or employment where you live

For each row: choose one:

• Fully
• Partly
• Not at all

Do you have any questions that have not yet been answered?

Choose one:

• Yes
• No

Please note your questions so the team can follow up with you.

Condition: Shown when questions remain

Open answer

The test may reveal findings unrelated to the reason for testing. Would you like to be told about them?

Choose one:

• Yes
• No
• I will decide later with my clinician

How would you like to receive your results?

Choose one:

• In person
• Video call
• Phone call
• Secure patient portal

Who else may receive a copy of your results? Select all that apply.

Choose any that apply:

• My family doctor
• My specialist
• A family member I name to the team
• No one else

May we store any sample left over after testing, in case further testing is useful later?

Choose one:

• Yes
• No

May your results be used for research after your name and identifying details are removed?

Choose one:

• Yes
• No

May we contact you in future if new information about your result or a relevant study becomes available?

Choose one:

• Yes
• No

Do you agree to have the genetic test?

Choose one:

• Yes
• No

If you are comfortable sharing it, what led to your decision not to be tested?

Condition: Shown when consent is declined

Open answer