DR. OZ’S TRANSFORMATION NATION Million dollar you in partnership with weight watchers.
Family History Worksheet
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1. Talk to your family – your parents and siblings, primarily – about their health history. If your siblings are unavailable, ask your next closest relatives: first cousins, aunts, and uncles, and grandparents.
2. Check the boxes next to the condition that a family member has. If more than one family member has the condition: note how many in the box.
3. Return to sharecare.com and enter your information. Keep this worksheet and take it with you to your doctor.
Condition Parent Sibling Other relative Alzheimer’s disease
Allergies
Anesthesia Issues
Arthritis
Arthritis, Rheumatoid
Asthma
Bleeding Issues
Cancer, Breast
Cancer, Colon Cancer, Lung
Cancer, Skin
Cancer, Prostate
Cancer, Ovarian
Cancer, Other
Depression
Diabetes, Type1 (Childhood
Diabetes, Type 2 (Adult
Epilepsy (seizures)
Eye conditions Glaucoma
Hearing problems
Heart disease, heart attack,
High blood pressure/ hypertension High cholesterol
Kidney disease
Lupus
Migraines
Osteoporosis
Thyroid disorders Tuberculosis
Other:
http://www.sharecare.come/home/transformationnation
on set)
stroke
Hypertension
onset)
- DR. OZ’S TRANSFORMATION NATION
- Family History Worksheet
- How to use this worksheet
- Family History Worksheet
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