Hi this is ______ from Quantum Wellness, we received your request for a Cancer Genetic Screening is _____ available?


Ok great I’m going to ask you some personal & health related questions that will serve as a medical intake. That will determine which test is best suited for you.


Have you ever taken an in home swab test for hereditary Cancer or Cardiomyopathy?

If so, when?


First Name :

Last Name :

Primary Phone Number :

Best Time To Contact :

And what is your email address so we can send you instructions and tracking information for your kit?



Date of Birth :

Address :

City :


Zip g

Ethnicity :

Gender :




Medicare/Insurance ID Number (NO DASHES/SPACES) *

Group # (If Private)

BIN # (If Private)

Doctor Name

Doctor Phone Number

Doctor NPI


Ok, so now I am going to ask you a few qualifying questions to see which test will work best for you.



Have you personally had cancer previously?

(if so which kind, age diagnosed )


Has anyone in your family had cancer? (if so who, which kind & age diagnosed)


Please answer yes or no to any of the following symptom that you personally or family member experienced (if Yes Who).


1.Cardiomyopathy (thickened or thinned heart muscle)

2.Arrhythmia (irregular heart rate)

3.Affected with aortic aneurysm (thoracic, abdominal)

4.Sudden unexpected death of unknown cause(ex. drowning of a good swimmer; sudden, unexplained car accident)

5.Syncope/fainting during exercise

6.Episodes of syncope/fainting during normal activity

7.Sudden or early heart attack

8.Cardiac arrest

9.Heart Failure or heart transplant


11.Elevated or high cholesterol levels


13.Any extracardiac features(muscle weakness, dysmorphic features, deafness)

14.Any problems with exercise

15.Any chronic illness (ex. Hypertension

16.Muscle disorder or muscular dystrophy



Now, have you EVER taken any medications for your heart? Any blood pressure meds or blood thinners?

How about any anti-depressants or anti-anxiety medicines?


Current Blood Pressure/Heart Medications, or Anti-Depressant/Anxiety Medications :

Past Blood Pressure /Heart Medications, or Anti-Depressant/Anxiety Medications:

OTC Medications:

















It looks like you qualify for this brand new genetic (Cardiomyopathy or Cancer)  test that is a benefit through your Medicare insurance.


Ok great, so it looks like the lab that will be handling your testing sample will be Capital Advantage Diagnostics.



We will be contacting your primary care physician within the next 24 to 48 hours to confirm your eligibility for the test. Your doctor may contact you to verify that you requested this testing. If needed, we may ask to do a conference call with you and your doctor.



Once we get the approval from your doctor the lab is going to mail your kit through express mail, which usually takes 2-3 business days.



The test will arrive in a white or red box labeled "Capital Advantage Diagnostics." Inside are instructions and a phone number so you can call and have a HIPPA Certified specialist walk you through the process.



The lab has full tracking on the package, so they can see when it has been delivered. If we do not hear from you within 1 or 2 days, you will be contacted by a HIPPA Certified specialist.



The Specialist will walk you through how to properly swab your cheeks, sign off on the requisition form, and re-package the sample with their pre-paid postage. The whole process is very simple and takes about 3 minutes from start to finish. Now the hardest part is left on you, that is putting it in the mailbox.



It's very important that you pick up when the specialist tries calling you. If they miss you, they will leave a voicemail. This is a new technology that Medicare is willing to pay for in order to save lives. It is ultimately up to you to communicate with the lab and get your sample sent back out as soon as possible. Your results will be mailed directly to you within 6 to 8 weeks from the time the lab receives your sample.



Now, do you have any questions for me?