Worksheet 1
Family Health History
At your first visit and perhaps subsequent visits, your doctor will likely ask you about your family’ s health history. A family medical history can identify people with a higher-than-usual chance of having common disorders, such as heart disease, high blood pressure, stroke, certain cancers, and diabetes. These disorders are caused by a combination of genetic factors, environmental conditions, and lifestyle choices. A complete family medical history should include information about your grandparents, uncles and aunts, cousins, parents, sisters, and brothers. This form can help you organize your thoughts about conditions and illnesses that have affected your family members. You can download more copies of this form at www. nia. nih. gov / health / twyd-worksheets.
Family Medical History
Family Member
Disease or Condition
Talking With Your Doctor 39