No risk	Unlikely	Neutral	Likely	Definite	Not applicable
Yourself	□	□	□	□	□	□
Your parents	□	□	□	□	□	□
Your grandparents	□	□	□	□	□	□
Your partner	□	□	□	□	□	□
Your child (ren)	□	□	□	□	□	□
A good friend	□	□	□	□	□	□
A close colleague	□	□	□	□	□	□
Other: … … (text)	□	□	□	□	□	□