Pancreatic Cancer Study

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Make an appointment with a cancer specialist today.
Call us at 800-KARMANOS (800-527-6266)

Patients and Visitors

Healthcare Professionals & Research

Ways to Give

PLEASE READ BEFORE COMPLETING APPLICATION

Participants will not receive "gene test results" from this study. Since one of the goals of this study is to understand the role of genes in familial pancreatic cancer, the meaning of an individual result may not be understood for some time until accrual and analysis of the data are complete.

All personal information received will be kept confidential as required by law.

First Name

Last Name

Telephone

Address1

Address2

City

State

select

Zip

* Country

* Have YOU ever been diagnosed with pancreatic cancer?
Yes No

* How many of you relatives were diagnosed with pancreatic cancer?

* Please check all the relatives who were diagnosed with pancreatic cancer:
Mother Father Sister Brother Grandmother Grandfather Aunt Uncle Niece Nephew Daughter Son Granddaughter Grandson Spouse Other

If you answered Other to the previous question, please indicate the relative(s) that was diagnosed with pancreatic cancer below.

Please type in any comments or questions here.

SUBMIT

The Barbara Ann Karmanos Cancer Center is accredited by The Joint Commission.
If members of the public have any quality-of-care or safety concerns, they may notify The Joint Commission at 630-792-5800.