www.nhsjewishbrcaprogramme.org.uk Open in urlscan Pro
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      <label class="nhsuk-label nhsuk-label--l m-0" for="fname"> 1. First name </label>
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  <div class="nhsuk-form-group">
    <h1 class="nhsuk-label-wrapper">
      <label class="nhsuk-label nhsuk-label--l m-0" for="sname"> 2. Last name </label>
    </h1>
    <input class="nhsuk-input nhsuk-input--width-10 " id="sname" name="sname" value="" type="text">
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  <div class="nhsuk-form-group ">
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      <legend class="nhsuk-fieldset__legend nhsuk-label--l m-0">
        <label class="nhsuk-label nhsuk-label--l m-0"> 3. Date of Birth </label>
      </legend>
      <div class="nhsuk-hint" id="example-hint"> For example, 15 3 1984 </div>
      <div class="nhsuk-date-input" id="DOB">
        <div class="nhsuk-date-input__item">
          <div class="nhsuk-form-group">
            <label class="nhsuk-label nhsuk-date-input__label m-0" for="DOB_day"> Day </label>
            <input class="nhsuk-input nhsuk-date-input__input nhsuk-input--width-2 " value="" id="DOB_day" name="DOB_day" type="text" pattern="[0-9]*" inputmode="numeric">
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        </div>
        <div class="nhsuk-date-input__item">
          <div class="nhsuk-form-group">
            <label class="nhsuk-label nhsuk-date-input__label m-0" for="DOB_month"> Month </label>
            <input class="nhsuk-input nhsuk-date-input__input nhsuk-input--width-2 " value="" id="DOB_month" name="DOB_month" type="text" pattern="[0-9]*" inputmode="numeric">
          </div>
        </div>
        <div class="nhsuk-date-input__item">
          <div class="nhsuk-form-group">
            <label class="nhsuk-label nhsuk-date-input__label m-0" for="DOB_year"> Year </label>
            <input class="nhsuk-input nhsuk-date-input__input nhsuk-input--width-4 " value="" id="DOB_year" name="DOB_year" type="text" pattern="[0-9]*" inputmode="numeric">
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  <div class="nhsuk-form-group">
    <fieldset class="nhsuk-fieldset">
      <legend class="nhsuk-fieldset__legend nhsuk-label--l m-0">
        <h1 class="nhsuk-fieldset__heading"> 4. Sex (assigned at birth) </h1>
      </legend>
      <div class="nhsuk-hint" id="example-with-hint-text-hint"> Please provide your sex as registered at birth </div>
      <div class="nhsuk-radios">
        <div class="nhsuk-radios__item">
          <input class="nhsuk-radios__input" id="sex_F" name="sex" type="radio" value="F">
          <label class="nhsuk-label nhsuk-radios__label" for="sex_F"> Female </label>
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        <div class="nhsuk-radios__item">
          <input class="nhsuk-radios__input" id="sex_M" name="sex" type="radio" value="M">
          <label class="nhsuk-label nhsuk-radios__label" for="sex_M"> Male </label>
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  </div>
  <div class="nhsuk-form-group">
    <h1 class="nhsuk-label-wrapper">
      <label class="nhsuk-label nhsuk-label--l m-0" for="phone"> 5. Telephone number </label>
    </h1>
    <div class="nhsuk-hint" id="example-with-hint-text-hint"> Please enter with no spaces, for example 01234567891, you should not include +44 </div>
    <input class="nhsuk-input " id="phone" name="phone" value="" type="text">
  </div>
  <div class="nhsuk-form-group">
    <h1 class="nhsuk-label-wrapper">
      <label class="nhsuk-label nhsuk-label--l m-0" for="email"> 6. Email address </label>
    </h1>
    <div class="nhsuk-hint" id="example-with-hint-text-hint"> For example, you@example.com </div>
    <input class="nhsuk-input " id="email" name="email" value="" type="text">
  </div>
  <div class="nhsuk-form-group">
    <fieldset class="nhsuk-fieldset">
      <legend class="nhsuk-fieldset__legend nhsuk-fieldset__legend--m ">
        <label class="nhsuk-label nhsuk-label--l m-0"> 7. Postal address </label>
      </legend>
      <div class="nhsuk-form-group">
        <label class="nhsuk-label" for="address-line-1"> Building and street <span class="nhsuk-u-visually-hidden">line 1 of 2</span>
        </label>
        <input class="nhsuk-input" id="address-line-1" name="address-line-1" value="" type="text">
      </div>
      <div class="nhsuk-form-group">
        <label class="nhsuk-label" for="address-line-2">
          <span class="nhsuk-u-visually-hidden">Building and street line 2 of 2</span>
        </label>
        <input class="nhsuk-input" id="address-line-2" name="address-line-2" value="" type="text">
      </div>
      <div class="nhsuk-form-group">
        <label class="nhsuk-label" for="address-city"> Town or city </label>
        <input class="nhsuk-input nhsuk-u-width-two-thirds" id="address-city" value="" name="address-city" type="text">
      </div>
      <div class="nhsuk-form-group">
        <label class="nhsuk-label" for="address-county"> County </label>
        <input class="nhsuk-input nhsuk-u-width-two-thirds" id="address-county" value="" name="address-county" type="text">
      </div>
      <div class="nhsuk-form-group">
        <label class="nhsuk-label" for="address-postcode"> Postcode </label>
        <div class="nhsuk-hint" id="example-hint"> Please enter with no spaces, for example BD971AF </div>
        <input class="nhsuk-input nhsuk-input--width-10" id="address-postcode" value="" name="address-postcode" type="text">
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    </fieldset>
  </div>
  <div class="nhsuk-form-group">
    <legend class="nhsuk-fieldset__legend nhsuk-fieldset__legend--m">
      <label class="nhsuk-label nhsuk-label--l m-0"> 8. NHS number </label>
    </legend>
    <div class="nhsuk-hint" id="example-with-hint-text-hint"> Your NHS number is a 10 digit number that you can find on any letter the NHS has sent you. Please enter with no spaces, for example 4857773456 </div>
    <input class="nhsuk-input nhsuk-input--width-10" id="NHSnumber" value="" name="NHSnumber" type="text" aria-describedby="example-with-hint-text-hint" inputmode="numeric">
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  <div class="nhsuk-form-group">
    <fieldset class="nhsuk-fieldset">
      <legend class="nhsuk-fieldset__legend nhsuk-fieldset__legend--m">
        <label class="nhsuk-label nhsuk-label--l m-0"> 9. Eligibility </label>
      </legend>
      <div class="nhsuk-hint" id="example-hint"> You are eligible to take part in this programme based on the following criteria:<br>
        <span>✓</span> you have at least one Jewish grandparent <br>
        <span>✓</span> you are 18 years or older <br>
        <span>✓</span> you receive NHS care in England<br>
      </div>
      <div class="nhsuk-radios nhsuk-radios--inline">
        <div class="nhsuk-checkboxes__item">
          <input class="nhsuk-checkboxes__input" id="eligibility" name="eligibility" type="checkbox" value="TRUE">
          <label class="nhsuk-label nhsuk-checkboxes__label" for="eligibility"> I confirm that I am eligible to take part (please check box) </label>
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  <div class="nhsuk-form-group">
    <fieldset class="nhsuk-fieldset">
      <legend class="nhsuk-fieldset__legend nhsuk-fieldset__legend--m">
        <label class="nhsuk-label nhsuk-label--l m-0"> (Optional) Please provide your Jewish denomination </label>
      </legend>
      <div class="nhsuk-form-group">
        <label class="nhsuk-label" for="select-1"> Included to help us direct engagement resources most efficiently. </label>
        <select class="nhsuk-select" id="jewish_denomination" name="jewish_denomination">
          <option value="" selected="" hidden="">Choose here</option>
          <option value="Charedi">Charedi</option>
          <option value="Orthodox_Observant">Orthodox Observant</option>
          <option value="Orthodox_Traditional">Orthodox Traditional</option>
          <option value="Reform">Reform</option>
          <option value="Liberal">Liberal</option>
          <option value="Masorti">Masorti</option>
          <option value="Unaffiliated/non-practising">Unaffiliated/non-practising</option>
          <option value="Prefer_not_to_say">Prefer not to say</option>
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  <div id="register" class="text-center m-3 text-base lg:text-lg">
    <em>By submitting this form, you are consenting for your details to be stored at the Institute of Cancer Research, London and the Royal Marsden NHS Foundation Trust​. You can read the privacy policy for the Institute of Cancer Research
      <a class="underline" href="https://www.icr.ac.uk/legal/privacy">here</a>, and for the Royal Marsden <a class="underline" href="https://www.royalmarsden.nhs.uk/privacy">here</a>. </em> ​<br>
    <button class="nhsuk-button mt-4 mb-0" type="submit"> Submit form </button>
  </div>
</form>

Text Content

NHS Jewish BRCA Testing Programme

An NHS programme offering BRCA-testing to those with Jewish ancestry

Did you know that people with Jewish ancestry are more likely to carry gene
faults in the BRCA genes?

These gene faults increase the risk for certain cancers. Cancer screening and
prevention options are available to people with BRCA gene faults.

You are eligible for genetic testing of the BRCA genes through the NHS if:
 * ✓ you have at least one Jewish grandparent 
 * ✓ you are 18 years or older 
 * ✓ you receive NHS care in England

If you would like to order a BRCA test, please complete the short form below
We will then contact you with further information about the testing process and
let you know how long you can expect to wait for your test.
Please register your interest in taking part by completing the short form below
Why is this genetic test helpful? read more
 * This genetic test can identify if you have a gene fault in BRCA1 or BRCA2. 
 * BRCA gene faults increase the risk for certain types of cancer. 
 * Learning if you have a BRCA1 or BRCA2 gene fault can:
   * - open cancer risk management options for you
   * - open cancer risk management options for your relatives
   * - provide information for family-planning

Who might benefit from different genetic testing services? read more
 * If you already know there is a gene fault in your family, you may wish to be
   referred directly by your GP to your local clinical genetics service for
   testing and support.
 * If you have had breast or ovarian cancer yourself, you may be eligible for
   more extensive genetic testing than that offered through this programme.
   Please check with your GP.

Further information and support is available throughout the process from a
genetic counsellor via our telephone helpline. read more
 * Support from a genetic counsellor is available via our telephone helpline on
   020 3437 6001 (open Monday to Friday, 9:00am to 5:00pm, with extended hours
   to 7:00pm on Wednesdays)
   
   Please phone the helpline to discuss any of the following topics with a
   genetic counsellor:
 * You can call our telephone helpline on 020 3437 6001 (open Monday to Friday,
   9:00am to 5:00pm, with extended hours to 7:00pm on Wednesdays) to speak to a
   genetic counsellor.
   
   Please phone the helpline to discuss any of the following topics with a
   genetic counsellor:
 * Help deciding if BRCA genetic testing is right for you
 * The potential impact of a positive or negative result for you
 * The potential impact of a positive or negative result for your family
 * Questions about your personal or family history of cancer
 * More general information about the BRCA genes, genetic testing, and cancer
   risk
 * Technical or administrative questions about the genetic testing process
 * Any other personal concerns or questions about BRCA genetic testing and
   hereditary cancer


Join our waiting list for testing

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If you have been informed by a relative about a BRCA gene fault within your
family, please contact our telephone helpline on 020 3437 6001 before completing
the form. Our helpline is available Monday to Friday, between 9:00am to 5:00pm,
with extended hours to 7:00pm on Wednesdays.


1. FIRST NAME


2. LAST NAME

3. Date of Birth
For example, 15 3 1984
Day
Month
Year


4. SEX (ASSIGNED AT BIRTH)

Please provide your sex as registered at birth
Female
Male


5. TELEPHONE NUMBER

Please enter with no spaces, for example 01234567891, you should not include +44


6. EMAIL ADDRESS

For example, you@example.com
7. Postal address
Building and street line 1 of 2
Building and street line 2 of 2
Town or city
County
Postcode
Please enter with no spaces, for example BD971AF
8. NHS number
Your NHS number is a 10 digit number that you can find on any letter the NHS has
sent you. Please enter with no spaces, for example 4857773456
9. Eligibility
You are eligible to take part in this programme based on the following criteria:
✓ you have at least one Jewish grandparent
✓ you are 18 years or older
✓ you receive NHS care in England

I confirm that I am eligible to take part (please check box)
(Optional) Please provide your Jewish denomination
Included to help us direct engagement resources most efficiently. Choose here
Charedi Orthodox Observant Orthodox Traditional Reform Liberal Masorti
Unaffiliated/non-practising Prefer not to say
By submitting this form, you are consenting for your details to be stored at the
Institute of Cancer Research, London and the Royal Marsden NHS Foundation Trust
. You can read the privacy policy for the Institute of Cancer Research here, and
for the Royal Marsden here.
Submit form
What happens next?

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Once you’ve completed the registration form for a BRCA test, we will post a
testing pack to your home address. We will email to confirm receipt of your
registration and to let you know when you should expect to receive your pack.
Waiting times during periods of high demand can vary. If you do not receive your
pack within the advised timeframe, you are welcome to call the Helpline. Once
you have returned your pack in the post, you can expect to receive your result
by letter within 16 weeks.



Support from a genetic counsellor is available via our telephone helpline on 020
3437 6001 (open Monday to Friday, 9:00am to 5:00pm, with extended hours to
7:00pm on Wednesdays) You can call our telephone helpline on 020 3437 6001 (open
Monday to Friday, 9:00am to 5:00pm, with extended hours to 7:00pm on Wednesdays)
to speak to a genetic counsellor.


You can also get in touch via email to jewishbrca.programme@nhs.net
Browse external resources View detailed patient information about BRCA testing