Cervixel

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A.Personal

Are you male or female?
This form is designed for women only
Have you ever been diagnosed with cancer, except for non-melanoma skin cancer?
Have you ever had a hysterectomy (a medical procedure to take out your uterus, sometimes your ovaries and/or all or part of your cervix)?
More information: Includes manufactured, hand-rolled, filtered, unfiltered and flavoured tobacco cigarettes.
Do you smoke cigarettes?
More information: Includes manufactured, hand-rolled, filtered, unfiltered and flavoured tobacco cigarettes.

B.Reproductive and Sexual History

The following questions ask about childbirth, sexual activity and birth control methods. If completing the risk assessment for someone else, please note that some questions concern personal matters.
How many sexual partners have you had in your life?
More information: This includes intercourse, sexual touching and oral sex with a partner of either gender.
How many times have you given birth?
More information: Having more than 1 baby at a time, such as delivering twins or triplets, counts as giving birth once.
Have you ever had a sexually transmitted infection (STI) also known as a sexually transmitted disease or STD? Examples include human papillomavirus virus (HPV), genital herpes, gonorrhea, chlamydia and HIV/AIDS.
* Genital herpes is caused by a virus and causes recurring painful sores on and around the genitals. * Gonorrhea is a bacterial infection also known as “the clap.” * Chlamydia is a bacterial infection that can cause sterility. *XThe human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS). HIV attacks the immune system, resulting in an ongoing illness.
Have you had a Pap test (also known as a Pap smear) within the last 3 years?

C.Screening

Here we’ll ask you about your history of Pap tests and whether you’ve had the HPV vaccine. Both of these can make a difference when it comes to your cervical cancer risk.
Have you had a Pap test (also known as a Pap smear) within the last 3 years?
A test done by a doctor or nurse that looks for abnormal cell changes on the cervix that could eventually lead to cancer.
Have you been vaccinated against HPV (that is, been given Gardasil® or Cervarix®)?
Vaccinations are usually given as a needle or “shot,” and protect you from diseases by boosting your body’s immune system.
If you want to to receive your assessment results please enter your email address blove

Kindly note: You’ll receive your test results after review by cervical specialists.”

Please enable JavaScript in your browser to complete this form.
Step 1 of 2

A.Personal

Are you male or female?
This form is designed for women only
Have you ever been diagnosed with cancer, except for non-melanoma skin cancer?
Have you ever had a hysterectomy (a medical procedure to take out your uterus, sometimes your ovaries and/or all or part of your cervix)?
More information: Includes manufactured, hand-rolled, filtered, unfiltered and flavoured tobacco cigarettes.
Do you smoke cigarettes?
More information: Includes manufactured, hand-rolled, filtered, unfiltered and flavoured tobacco cigarettes.

B.Reproductive and Sexual History

The following questions ask about childbirth, sexual activity and birth control methods. If completing the risk assessment for someone else, please note that some questions concern personal matters.
How many sexual partners have you had in your life?
More information: This includes intercourse, sexual touching and oral sex with a partner of either gender.
How many times have you given birth?
More information: Having more than 1 baby at a time, such as delivering twins or triplets, counts as giving birth once.
Have you ever had a sexually transmitted infection (STI) also known as a sexually transmitted disease or STD? Examples include human papillomavirus virus (HPV), genital herpes, gonorrhea, chlamydia and HIV/AIDS.
* Genital herpes is caused by a virus and causes recurring painful sores on and around the genitals. * Gonorrhea is a bacterial infection also known as “the clap.” * Chlamydia is a bacterial infection that can cause sterility. *XThe human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS). HIV attacks the immune system, resulting in an ongoing illness.
Have you had a Pap test (also known as a Pap smear) within the last 3 years?

C.Screening

Here we’ll ask you about your history of Pap tests and whether you’ve had the HPV vaccine. Both of these can make a difference when it comes to your cervical cancer risk.
Have you had a Pap test (also known as a Pap smear) within the last 3 years?
A test done by a doctor or nurse that looks for abnormal cell changes on the cervix that could eventually lead to cancer.
Have you been vaccinated against HPV (that is, been given Gardasil® or Cervarix®)?
Vaccinations are usually given as a needle or “shot,” and protect you from diseases by boosting your body’s immune system.
If you want to to receive your assessment results please enter your email address blove

For a convenient cervical cancer screening option, order a self-test kit

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