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Information Leaflets & Forms

Home > Services > Departments A-Z > Department of Clinical Genetics > Information Leaflets & Forms
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Forms

To download forms, please click on links below

How to be referred to a Genetics clinic

How to be referred to DCG.pdf

Referral criteria for individuals with a Family History of Cancer

Referral criteria for individuals with a Family History of Cancer.pdf

Genetics Family Cancer History Questionnaire

Genetics Family History Cancer Questionnaire.pdf

Breast cancer – Information for GPs

BRCA GP info.pdf

Request form for genetic testing

Click here to Download Genetic Analysis Form

Procedure for completing the Request for Genetic Analysis form

Click here for the Procedure for completing the Request for Genetic Analysis form

Huntington Disease test consent form

Click here to Download Consent Form for Huntington Disease

Cystic Fibrosis Patient information request form

Click here to Download CF Genetic Testing Questionnaire Form

 

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Guide for Visiting CHI at Crumlin
  • Visiting restrictions changed during Level 5 restrictions
  • Only 1 nominated parent / guardian can be with their child at any time
  • Parents/guardians can now alternate who stays with their child
  • Do not attend if you have any symptoms of COVID-19, are a close contact or are awaiting a Covid-19 swab result
  • Tell a staff member if you become unwell when at CHI
  • Parents/guardians and children 13 years and over must wear a face mask
  • Wash your hands frequently
  • Walk on the right side of the corridor inside the hospital

COVID-19 Guidance for Families