We Can Assist You
(386) 230-4118
Expert Agents Available Now

Lock In Your Cancer Genetics Test Today!
START v 0% COMPLETED
What is your gender?
MALE
FEMALE
Which of the following conditions do you OR your family members have/had?
Thickened or thinned heart muscle? (Cardiomyopathy)
Who in your family has/had cardiomyopathy?
At approximately what age were you/they diagnosed?
Irregular heart rate? (Arrhythmia)
Who in your family has/had arrhythmia?
At approximately what age were you/they diagnosed?
Affected with aortic aneurysm? (Thoracic, Abdominal)
Who in your family has/had aortic aneurysm?
At approximately what age were you/they diagnosed?
Sudden, unexpected death of unknown cause? (Drowning of a good swimmer; sudden unexplained car accident, etc...)
Which family member had an unexpected sudden death?
At approximately what age did they have a sudden death?
Fainting during exercise?
Who in your family faints/fainted during exercise?
At approximately what age were you/they diagnosed?
Fainting during normal activity?
Who in your family faints/fainted during normal activity?
At approximately what age were you/they diagnosed?
Sudden or early heart attack?
Who in your family has had a sudden or early heart attack?
At approximately what age did they have a heart attack?
Cardiac Arrest?
Who in your family has had cardiac arrest?
At approximately what age did they have cardiac arrest?
Heart failure or a transplant?
Who in your family has/had heart failure or a transplant?
At approximately what age was their heart failure or transplant?
Has a pacemaker?
Who in your family has/had a pacemaker?
At approximately what age did they get a pacemaker?
Elevated or high cholesterol levels?
Who in your family has/had elevated or high cholesterol levels?
At approximately what age were you/they diagnosed?
Atherosclerosis?
Who in your family has/had atherosclerosis?
At approximately what age were you/they diagnosed?
Extracardiac features? (muscle weakness, dysmorphic features, deafness)
Who in your family has/had extracardiac features?
At approximately what age were you/they diagnosed?
Any problems with exercise?
Who in your family has/had problems with exercise?
At approximately what age were you/they diagnosed?
Any chronic illness? (Example: hypertension)
Who in your family has/had chronic illness?
At approximately what age were you/they diagnosed?
Muscle disorder or muscular dystrophy?
Who in your family has/had a muscle disorder or muscular dystrophy?
At approximately what age were you/they diagnosed?
Continue
Please complete all input fields marked with red before continuing.
What is your name?
Continue
  We require your email address to keep you up to date with the status of your Hereditary Cancer Genetics Test.
What is your email address?
Continue
What is your date of birth?
Continue
Do you currently have cancer?
Yes
No
What type of cancer(s) do you currently have?
Please select all that apply.
Continue
Have you previously had cancer?
Yes
No
What type of cancer(s) did you previously have?
Please select all that apply.
Continue
At what age were you diagnosed with cancer?
(Enter a number for your age of diagnosis)
Continue
Have you previously taken a molecular genetic screening test?
(That was billed through your insurance)
Yes
No
Are you currently taking any of the following types of medications?
Please select all that apply.
Continue
Are you planning or scheduled to have surgery?
YES
NO
What insurance do you have?
Continue
  We require your Insurance ID to verify your benefits. This allows us to determine whether or not your plan has coverage for Diagnostic Testing.
Enter your Insurance ID:
Continue
Do you have a Medicare Advantage/Supplemental Plan?
Yes
No
Who is your Advantage/Supplemental Plan through?
Continue
Enter your Medicare Advantage/Supplemental Plan ID:
Continue
  Your phone number will remain confidential. It will only be used to contact you regarding your Interest in our Genetic Test.
What is your phone number?
Continue
What is your address?
Your almost done! Just enter your address below.
Request My Kit!
By clicking 'Request My Kit', I agree the following: To receive marketing communications, including all automated calls and text messages (SMS), artificial or pre-recorded messages, and emails from The Health Awareness Project (HAP, LLC), it’s agents, representatives and affiliates, and partner companies. I understand that my consent to these communications is not a condition of purchasing any goods or services, I may incur charges for these communications, and I can revoke my consent at any time. I am willing to speak with an Agent who is certified to discuss The Health Awareness Project’s products/services. This will NOT obligate me to any product/service offering, unless I solely accept, nor affect my current insurance plan, or enroll me in a Medicare plan.