Medical experts recommending going back three generations for family health history, and
this handy organizer makes it easy!

With My Family Health History Form, no more scratching your head in the middle of a medical appointment, trying to remember which relative had which condition and at what age. 


Simply download the form and fill it out electronically to print and take along on doctor’s appointments. (You can also print out the blank form and complete it by hand if you prefer)


I remember when I first met with a genetic counselor, she asked extensive family health history questions, and I felt totally unprepared. 

I thought I had a good grasp of it, until I had to recall the information on the spot. It would have been so much better had I gathered all the details and organized them ahead of time. 
 
I've made it easier for you so that you can be better prepared for any new doctor visit!

With My Family Health History Form, you can take the time to collect thorough information ahead of time and then record it all in one place. This handy form is fillable, or you can print it out and complete it by hand if you prefer.

Includes space to record your own medical information, plus: 

  • First Degree Relatives - your children, parents and siblings 
  • Second Degree Relatives - your grandchildren, grandparents, half-siblings, aunts, uncles, nieces and nephews 
  • Third Degree Relatives - your first cousins, great grandparents, great grandchildren, great aunts, great uncles, half-aunts, half-uncles, great nieces, great nephews


And it's yours - absolutely FREE!


Family Health History Form$0


About Me...
Jennifer Ervin

I'm a freelance writer and author, as well as a breast cancer "previvor-turned-survivor" carrying a mutation in one of the "breast cancer genes," specifically the CHEK2 gene. My family history of breast cancer and the devastating loss of cherished loved ones to the disease prompted my journey of extensive research, self-reflection and self-advocacy in the face of my hereditary risk. After undergoing a bilateral prophylactic mastectomy, my post-surgery pathology report revealed that a cancerous tumor had been slowly growing undetected - even with enhanced surveillance - for years. That’s when I went from being a “previvor” to a “survivor.” I credit my intuition and the surgery with saving my life.


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Family Health History Form$0

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