Hereditary Cancer Genetic Counseling Questionnaire and Patient Acknowledgement

1. Please complete and return the following form to Natera:

   Hereditary Cancer Questionnaire

   Please review the Genetic Counseling Patient Acknowledgement

   Send completed form to Natera Telehealth via fax (650-412-2305) or secure email (telehealthgc@natera.com). Alternatively, you may return the completed form to your healthcare provider and request that they forward it to Natera.

   Please see our Patient Privacy Policy, which describes how medical information about you may be used and disclosed; and, how you can get access to this information.

During your appointment:

1. Please go to a quiet place where you will be able to discuss your health. A support person may join you on video.
2. Log into Zoom a few minutes before the scheduled appointment time. The Natera genetic counselor will admit you to the video session. The appointment will last up to 60 minutes.

After your appointment:

1. Natera will send a summary of the visit to your clinic. If you would like to have any of the genetic tests/evaluations that were discussed, please let your doctor know so that they may order/request them for you.
2. Natera will bill your insurance for the genetic counseling visit.