A Game Plan to fight cancer and
other chronic diseases for Women
NAME:
NAME:
DATE OF BIRTH:
CURRENT AGE:
FAMILY HISTORY OF
CANCER AND OTHER
CHRONIC DISEASES*:
TALK TO MY DOCTOR
ABOUT SCREENING AND
EARLY DETECTION FOR:
A Game Plan to fight cancer and
other chronic diseases for Men
DATE OF BIRTH:
CURRENT AGE:
FAMILY HISTORY OF
CANCER AND OTHER
CHRONIC DISEASES*:
MY SCREENING
YEAR
DATE OF MY LAST
SCREENING
TALK TO MY DOCTOR
ABOUT SCREENING AND
EARLY DETECTION FOR:
MY SCREENING
YEAR
DATE OF MY LAST
SCREENING
BREAST CANCER
COLORECTAL CANCER
COLORECTAL CANCER
PROSTATE CANCER
CERVICAL CANCER
BLOOD PRESSURE
DIABETES
HIGH CHOLESTEROL
BLOOD PRESSURE
DIABETES
HIGH CHOLESTEROL
ADDITIONAL NOTES & QUESTIONS TO ASK MY DOCTOR (Make a list
of things you’d like to discuss with your doctor at your next visit).
ADDITIONAL NOTES & QUESTIONS TO ASK MY DOCTOR (Make a list of
things you’d like to discuss with your doctor at your next visit)
*If you are at higher risk for developing certain cancers or chronic
diseases, your doctor may recommend that you begin screening
sooner or more often.
*If you are at higher risk for developing certain cancers or chronic
diseases, your doctor may recommend that you begin screening
sooner or more often.