6. Have you, your partner, or anyone in either of your families had any of the following?
Down Syndrome (Mongolism / Trisomy 21) or other chromosome problem
Neural tube defect (opening in the spine, spina bifida, anencephaly)
Mental Retardation / developmental delay
Fragile X syndrome
Muscular dystrophy or other muscle or nerve problems
Hemophilia or any other bleeding disorder
Other genetic condition
7. Have you, your partner, or anyone in your families had a birth defect? (such as: cleft lip, blindness, deafness, hydrocephaly (water on the brain), etc.)
8. Have you, your partner or any other family member been born with a heart defect?
9. Do you or your partner have a history of three or more miscarriages or a stillbirth?
10. Many common diseases such as cancer or Alzheimer’s disease may have a genetic cause. This is more likely if there are several family members with the same health problems. Is there any major health problem that is common in your family?