1. Is your age 50 or above?
Yes   No
2. Have you ever had polyp or intestine cancer?
Yes   No
3. Has anyone in your family (close relative) had polyp or intestine cancer?
Yes   No
4. Do you have Crohn’s disease or Ulcerative Colitis ?
Yes   No
5. If you are a woman: Have you had breast, ovary or endometrium cancer?
Yes   No