Becoming a Patient

Your risk will be based on the information you provide. Your genetic counselor will ask questions about your medical history and the medical history of your relatives such as siblings, parents, aunts, uncles, and grandparents. Here’s what to expect during your visit:

• We will ask about your medical history and the medical history of your relatives
• We’ll talk with you about important issues such as what to do with your information and who to tell
• If we need more information, we may ask you to follow up or help you get records
• We’ll discuss ways to help lower your risk for cancer
• If your family history suggests a hereditary syndrome, we will offer genetic testing
• Depending on your results, we’ll develop an appropriate and tailored plan for your needs

Patient's Name
Date of Birth
Adress
City	State Zip Code
Home Phone	Cell Phone
Insurance Company
Name of Insured
Insurance Phone
Referring Provider
Referring Provider's Address
City	State Zip Code
Referring Provider's Phone	Fax
Documents that will be faxed:	Patient Exam/ Medical Records Copy (front and back) of Insurance Card Insurance preauthorization, If applicable Other
Notes for Genetic Counselor

You may send this information to:
Jessica Grzybowski, Genetic Counselor
Office Phone: 312-413-7330
Fax: 312-996-5103
Email: jgrzy@uic.edu
Office Address: 840 South Wood Street (MC 716)
Digestive Diseases and Nutrition Room 740
Chicago, IL 60612

 

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• What is Genetic Counseling?
  
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