中文
主頁
遺傳咨詢
關於我們
聯繫我們
小常識
醫學新聞
註冊（正在構建中，尚未完成）
English
Discovery Genetics
Genetic Counseling
Basic Information
Discussion
Company
Team
Contact
中文
主頁
遺傳咨詢
關於我們
聯繫我們
小常識
醫學新聞
註冊（正在構建中，尚未完成）
English
Discovery Genetics
Genetic Counseling
Basic Information
Discussion
Company
Team
Contact
Intake Questionnaire
Patient Information
Name
*
First Name
Last Name
Email
*
Date of Birth
*
MM
DD
YYYY
Number of Family Members (related by blood, either living or deceased)
Grandparents
Mother
Father
Aunts (either side of family)
Uncles (either side of family)
Sisters
Brothers
Daughters
Sons
Half-sisters
Half-brothers
Immediate Family Information
Relation 1
Relationship
Thank you!
