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Endoscopy Centre

Health Check Items
Colon
Esophagus and Stomach
Liver
Pancreas and bile duct system
Small Bowel
General Enquiry
GI Disease Assessment
Colorectal Cancer Risk
Irritable Bowel Syndrome (IBS) Assessment
Gastroesophageal Reflux Disease (GERD) Assessment
Checking referral
Checking referral
Colorectal Cancer Risk

Colorectal Cancer Risk* Compulsory fields

Your Name*

Date of Birth*

Telephone No.*

Residential District

Height (m)*

If 5 feet 3 inches = 1.6m

Weight (kg)*

If 140 lbs = 63kg

Please complete the below questionnaire

1Gender

2Do you have any of the below colorectal cancer symptoms?

3Do you have any first degree relative(s) (parents, siblings or children) diagnosed with colorectal polyp, advanced adenoma or cancer?*

Age

4Have you done colorectal cancer screening with any of the below screening tool?

5Have you been diagnosed with the below colorectal disease?

Please choose

6Have you been diagnosed with the below disease or encounter situation below?

7Have you been diagenosed with the below disease?

If "tick" others, please write down the disease

8Have you ever had abdominal operation?

Type of Operation

9Do you warfarin or anti?

Please choose

10Do you smoke?

Risk of colorectal cancer

Low/Moderate Risk

After preliminary assessment, your risk of colorectal cancer is low/moderate. We would like to advise you to undergo colorectal cancer screening regularly. Colonoscopy will be one of the best screening tools, while fecal occult blood test is of second priority. Should you have further query, please feel free to contact us at 2637 0355.

Risk of colorectal cancer

Low/Moderate Risk

After preliminary assessment, your risk of colorectal cancer is low/moderate. We would like to advise you to undergo colorectal cancer screening regularly. Colonoscopy will be one of the best screening tools, while fecal occult blood test is of second priority. Should you have further query, please feel free to contact us at 2637 0355.

Risk of colorectal cancer

High Risk

After preliminary assessment, your risk of colorectal cancer is high. We would like to advise you to undergo colorectal cancer screening. Should you have further query, please feel free to contact us at 2637 0355.