Book a test – On Campus #2 – Jnetics | Prevention and management of Jewish genetic disorders in the UK

Step 1 of 3

Name*

Title First Last

Date of Birth*

Email (non-academic email address)*

Please use a personal email address, to ensure that you can keep your records after your university time.

Addresses

Address at University (i.e. term-time address)*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Home Address*

Same as University (term time) address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Where should we send your screening pack to? Where you will be on the date of the appointment?*

University

Home

Please note that you will need your pack for your appointment, which will be between the 20th-26th November.

FAMILY HISTORY

Please note:

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

The information you provide enables us to give you the most appropriate risk assessment.

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 biological grandparent?*

Yes

Please count living or deceased grandparents.

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

How many Ashkenazi Jewish grandparents do you have?*

How many Sephardi/Mizrahi Jewish grandparents do you have?*

What is/are the country/countries of origin of your Sephardi/Mizrahi grandparents?

Do you have any relatives who are CARRIERS of any of the conditions we test for?*

Yes

Click here for a full list of the recessive disorders covered by our test.
A carrier is unaffected by the recessive disorder themselves but can pass the mutated gene onto their children.

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

e.g. mother, half brother, father’s sister’s son.

If yes, before attending your screening, please scan and send a copy of any relevant report/genetic results letter to North West Thames Regional Genetics Service and include a note of your name, date of birth and date of screening.

Do you have any relatives who HAVE/HAD any of the conditions we test for?*

Yes

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

Please state the condition(s) and how you are related to the affected family member(s).

e.g. mother, half brother, father’s sister’s son

NHS GP & Surgery (name and address, including postcode):*

If the results show you are a carrier of one of the disorders tested for, a copy of your report and letter will be emailed to your GP.

Surgery Email:

If you are unable to provide their email address please provide as many details as you can in the field above. Without an email address we cannot guarantee that they will receive a copy of the results.

How did you hear about Jnetics on Campus University Screening Week?*

Please give more detail about your previous answer.

Jnetics on Campus Rep

PLEASE READ THIS SECTION CAREFULLY

Screening involves providing a buccal cheek swab. In a small number of cases, we may have to request a second 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.
Reports are delivered by the laboratory to the Jnetics genetic counsellor and securely stored at the North West Thames Regional Genetics Service (Northwick Park Hospital).
Test results are emailed to you up-to 20 weeks after your appointment; results are sent directly from Jnetics’ dedicated NHS Genetic Counsellor and includes their contact details if you have any questions.
Your test results are strictly confidential – they will be shared with you and your GP only and not with any additional parties unless you request otherwise.

Please note your results will be sent from LNWH-TR.jnetics@nhs.net, so please check your junk folder.

Agreements*

At the screening, we will be obtaining a DNA sample. Please read the below statements and select to indicate consent. You will have the opportunity to discuss any further questions at the screening.

I consent to being tested for carrier status for the 47 conditions on the Jnetics screening panel.

I give permission for my personal information to be securely shared with the trained Jnetics screening advisor who will conduct my consultation.

I give permission for my results to be shared by the Genetics Service with other healthcare professionals in order to assist testing a relative.

Jnetics promise to always keep your details safe, and we will never sell or share your details; please see our Privacy Policy for more details.

By accepting you confirm that all the information you have provided to us is true to the best of your knowledge and you agree to attend the appointment.*

I accept

I don't accept

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

Recessive Carrier Testing

NHS Jewish BRCA Testing

FAQs

Complete your booking

Addresses

FAMILY HISTORY

Please note:

Contact us

More information

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NHS Jewish BRCA Testing #text-88023283 { font-size: 1rem; line-height: 1; }

FAQs #text-4018581555 { font-size: 1rem; line-height: 1; }

Complete your booking

Addresses

FAMILY HISTORY

Please note:

Recessive Carrier Testing

NHS Jewish BRCA Testing

FAQs