Book a Test

The Jnetics Clinic operates virtually, please register below in order to receive a ‘screening pack’ in the post. Then you will be asked to complete an e-learning module, before completing the test at home and posting the kit back to Jnetics. It will then take 8-10 weeks to receive the results.

Recessive Screening Clinic Booking Form

URL

This field is for validation purposes and should be left unchanged.

Please note:

Only complete this form if you, or your partner, have at least one Jewish grandparent.

We cannot test siblings via the couple's pathway, as results are analysed together to look at a couple's risk to their future children. Siblings need to test as two separate individuals.

The Jnetics Clinic runs virtually, we will post you a tests kit to complete at home. All participants are required to watch an educational video prior to undertaking the test.

This test does NOT include the BRCA1 or BRCA2 genes

Appointment Type(Required)

Individual

Couple

Are you or your partner pregnant?(Required)

Yes

How many weeks pregnant, LMP and due date?

Have you tested through Jnetics before?(Required)

Yes

Where and when did you previously test?(Required)

E.g. JFS 2016

Your Details (Lead Booker)

Name(Required)

Title First Last

Please complete your full name as on your medical records.

Date of Birth (DD/MM/YYYY)(Required)

Gender at birth:(Required)

Male

Female

Marital Status:(Required)

Address - The address provided will be used by Jnetics for postage of the ‘screening pack’ prior to your appointment.(Required)

Street Address Address Line 2 City County Postcode Country

Phone(Required)

Email(Required)

Please note:

You may need to contact family members in order to give complete answers to these questions.

Ashkenazi refers to Jews who originated from Central or Eastern Europe. Sephardi/Mizrahi refers to those who come from Spain/Portugal, Southern Europe, North Africa, Central & Western Asia and the Middle East.

Do you have at least one Jewish grandparent?(Required)

Yes

Please contact the office at screening@jnetics.org or call 020 8158 5123 before proceeding with this form.

How many Ashkenazi Jewish grandparents do you have?(Required)

Please count living and deceased grandparents.

How many non-Ashkenazi Jewish grandparents including of Sephardi/Mizrahi origin do you have?(Required)

Please count living and deceased grandparents.

How many non Jewish grandparents do you have?(Required)

Please count living and deceased grandparents.

If you have any non-Ashkenazi grandparents, what is their country of origin?

Do you have any relatives who have/had any of the conditions we test for?(Required)

Yes

Unknown

Click here for a full list of the disorders covered by our test.

Please state the condition(s) and how you are related to the family member(s):(Required)

Do you have relatives who are (healthy) carriers of any of the conditions we test for?(Required)

Yes

Unknown

Please state the condition(s) and how you are related to the family member(s):(Required)

Please request a laboratory report or letter if any relatives are carriers or affected by any of the conditions on our panel so the Jnetics test is as accurate as possible.

Do you have a copy or does your GP/hospital/clinic have a relevant report/genetic results letter?(Required)

Yes

If YES, before screening, please scan and send a copy of this report to the CRGH admin team jnetics@crgh.co.uk and include a note of your name, date of birth and date of screening.

If you or your family have any other genetic disorders that could be relevant for our genetic councillor to be aware of please state them below.

If you provide us with your GP details, a copy of your report and letter will be sent to your GP. However please note, if you are unable to provide your GP's full details, we cannot guarantee that they will receive a copy of the results.

NHS GP Surgery Name & Address

GP Name Address Line 1 City County Postcode Country

GP Email

Partner Details

Name(Required)

Title First Last

Please complete your full name as on your medical records.

Date of Birth (DD/MM/YYYY)(Required)

Gender at birth:(Required)

Male

Female

Marital Status:(Required)

What is your relationship to the lead booker?(Required)

Please specify:(Required)

Is your address the same as your partner's?(Required)

Yes

Address(Required)

Street Address Address Line 2 City County Postcode Country

Please note:

An additional £10 will be added to your booking to cover international postage fees.

Please ensure these details differ from the lead booker's.

Phone(Required)

Email(Required)

Please note:

You may need to contact family members in order to give complete answers to these questions.

Ashkenazi refers to Jews who originated from Central or Eastern Europe. Sephardi/Mizrahi refers to those who come from Spain/Portugal, Southern Europe, North Africa, Central & Western Asia and the Middle East.

Do you have at least one Jewish grandparent?(Required)

Yes

No

Please contact the office at screening@jnetics.org or call 020 8158 5123 before proceeding with this form.

How many Ashkenazi Jewish grandparents do you have?(Required)

0

1

2

3

4
Please count living and deceased grandparents.

How many non-Ashkenazi Jewish grandparents including of Sephardi/Mizrahi origin do you have?(Required)

0

1

2

3

4
Please count living and deceased grandparents.

How many non Jewish grandparents do you have?(Required)

0

1

2

3

4
Please count living and deceased grandparents.

If you have any non-Ashkenazi grandparents, what is their country of origin?

Do you have any relatives who have/had any of the conditions we test for?(Required)

Yes

No

Unknown

Click here for a full list of the disorders covered by our test.

Please state the condition(s) and how you are related to the family member(s):(Required)

Do you have relatives who are (healthy) carriers of any of the conditions we test for?(Required)

Yes

No

Unknown

Please state the condition(s) and how you are related to the family member(s):(Required)

Please request a laboratory report or letter if any relatives are carriers or affected by any of the conditions on our panel so the Jnetics test is as accurate as possible.

Do you have a copy or does your GP/hospital/clinic have a relevant report/genetic results letter?(Required)

Yes

No
If YES, before screening, please scan and send a copy of this report to the CRGH admin team jnetics@crgh.co.uk and include a note of your name, date of birth and date of screening.

If you provide us with your GP details, a copy of your report and letter will be sent to your GP. However please note, if you are unable to provide your GP's full details, we cannot guarantee that they will receive a copy of the results.

Is your NHS GP surgery the same as your partner's?

Yes

No

NHS GP Surgery Name & Address
GP Name Address Line 1 City County Postcode Country

GP Email

Where did you hear about the Jnetics clinic?(Required)
Word of mouth (e.g. friend or family)
Synagogue/Rabbi
GP
Social media
Maccabi Southern Football League
Event (e.g. Jnetics talk, Young Professional event, Smashing the Glass)
Other

Please specify(Required)

PLEASE READ THIS SECTION CAREFULLY

Screening involves providing a cheek swab. In a small number of cases, we may have to request a second saliva sample if the amount of DNA extracted is insufficient.

This test detects the vast majority of all genetic changes in the genes covered. However, this test, as with all genetic tests, cannot detect all possible changes.

Jnetics works in partnership with the Centre for Reproductive and Genetic Health (CRGH), reports are delivered from the testing laboratory to the genetics counselling team at CRGH. The results, along with your booking information and consent forms will be securely stored by CRGH who will retain this information within their patient database in line will all applicable regulation.

Test results are shared with you from CRGH via a secure portal 8-10 weeks from receiving sample at Jnetics unless advised otherwise.

Consent

Full Name(Required)

Signature(Required)
Your Name
Your Name
Your Name

Where did you hear about the Jnetics clinic?(Required)
Word of mouth (e.g. friend or family)
Synagogue/Rabbi
GP
Social media
Event (e.g. Jnetics talk, Young Professional event, Smashing the Glass)
Other

Please give more detail.(Required)

PLEASE READ THIS SECTION CAREFULLY

Partner 1 Full Name(Required)

Partner 1 Signature(Required)
Your Name
Your Name
Your Name

Partner 2 Full Name(Required)

Partner 2 Signature(Required)
Your Name
Your Name
Your Name

We would like to keep in touch and update you about the work we do and how you can support Jnetics. You can update your communication preferences at any time. I am happy to hear from Jnetics by:
Email
Phone
SMS
Post

Payment

Total

Credit Card(Required)

Postage dates

Samples will next be posted to the lab on Thursday 24th September.

Recessive Carrier Testing

BRCA Testing

FAQs

Book a Test

Recessive Screening Clinic Booking Form

Please note:

Your Details (Lead Booker)

Please note:

Please request a laboratory report or letter if any relatives are carriers or affected by any of the conditions on our panel so the Jnetics test is as accurate as possible.

If you provide us with your GP details, a copy of your report and letter will be sent to your GP. However please note, if you are unable to provide your GP's full details, we cannot guarantee that they will receive a copy of the results.

Partner Details

Please note:

Please note:

Please request a laboratory report or letter if any relatives are carriers or affected by any of the conditions on our panel so the Jnetics test is as accurate as possible.

If you provide us with your GP details, a copy of your report and letter will be sent to your GP. However please note, if you are unable to provide your GP's full details, we cannot guarantee that they will receive a copy of the results.

PLEASE READ THIS SECTION CAREFULLY

Consent

PLEASE READ THIS SECTION CAREFULLY

Consent

Payment

Postage dates

Contact us

More information

Recessive Carrier Testing #text-2490252200 { font-size: 1rem; }

BRCA Testing #text-1072933970 { font-size: 1rem; line-height: 1; }

FAQs #text-419070712 { font-size: 1rem; line-height: 1; }

Book a Test

Recessive Screening Clinic Booking Form

Please note:

Your Details (Lead Booker)

Please note:

Please request a laboratory report or letter if any relatives are carriers or affected by any of the conditions on our panel so the Jnetics test is as accurate as possible.

If you provide us with your GP details, a copy of your report and letter will be sent to your GP. However please note, if you are unable to provide your GP's full details, we cannot guarantee that they will receive a copy of the results.

Partner Details

Please note:

Please note:

Please request a laboratory report or letter if any relatives are carriers or affected by any of the conditions on our panel so the Jnetics test is as accurate as possible.

If you provide us with your GP details, a copy of your report and letter will be sent to your GP. However please note, if you are unable to provide your GP's full details, we cannot guarantee that they will receive a copy of the results.

PLEASE READ THIS SECTION CAREFULLY

Consent

PLEASE READ THIS SECTION CAREFULLY

Consent

Payment

Postage dates

Recessive Carrier Testing

BRCA Testing

FAQs