Family Medical History Form: Fill & Download for Free

My annual pap-smear resulted in a biopsy and tearful news. I needed to have pre-cancerous tissue removed from my cervix.During my initial visit with the specialist that my family doctor referred me to, we were discussing family medical history. Mine is like a jigsaw puzzle with pieces that are wet and soggy from being gnawed and teethed on by the baby, then pee'd on by the family dog. Many broken families and step and half-relatives and with the few relatives still alive, differing stories and recounts by each one and then there is the mental state with waning memories, if they have any at all. Obtaining my family medical history is more than a little difficult.While I stumbled through the surgeon’s questions, answering to the best of my abilities; in a harsh, annoyed, and scoldingly loud voice she interrupted my explanation as to why I didn't know the exact 3 different cancers my older half sister (whose mother kept her hidden away without knowing who her father or me was) had battled. “It is your responsibility to know this!" she bellowed at me. Even after hearing what I was saying she seemed to not understand that in addition to my secret half sister, nearly all living relatives on my missing birth mother’s side suffered with schizophrenia and did not have the capacity to provide me with their history. She kept insisting that I was at fault for my lack of knowledge. She was a horrid doctor to which after all was said and done, I informed my family doctor about her demeanor and he never referred another patient to her again. Even during surgery she was…. snotty. As she was making the first incision on my cervix, tears began to fall. I could feel her cutting and it hurt. The assistant took notice and asked me if I was okay. I told her it hurt. The surgeon’s response? “Well, I gave you [random number here ] CC's of [random number ] percent!” And with a huff and a roll of the eyes she went to get more medication to numb my cervix and finish removing the tissue.Very cold. Brrrrrr…

Breast cancer is a disease that occurs when cells in the breast tissue change (or mutate) and keep rapidly dividing. Breast cancer is the most common cancer in women and is the leading cause of cancer-related deaths in women around the world. The risk of breast cancer usually increases with an increase in age.1. Know the risk factors2. Know the warning signs3. Mammograms save lives4. Know your family medical history5. Know how to do a self-breast examination6. Seek the right doctor and treatment7. Seek a second opinion

I am an adoptee. I was adopted when I was few months old. At the time of this encounter with a doctor, I did not know anything about my birth parents other than they were both teenagers when I was born.Every doctor I have ever seen has asked for medical history from my biological family. My primary physician that I had for several years had recently retired and I had to find someone new. A coworker had recommended a particular doctor, so I signed up to have him as my PCP fir the purpose of my insurance plan. I had no immediate need to see him, however I was pregnant at the time and my obstetrician was taking care of anything I needed at that time.After my daughter was born, I decided to get acquainted with my new doctor. I made an appointment and was given the usual clipboard and forms to complete. Of course it asked about family medical history and as usual, I left it blank.When I was called into the exam room, Dr A asked me why I left the history portion blank. When I explained that I was an adoptee. He glared at me and told me that in his native country (India) that being adopted meant that you were a discarded, unworthy person who was the lowest of the low. I was essentially told by this doctor that I was equivalent to a piece of fecal matter.I was in shock and didn't say a word. Being only a few weeks postpartum, my moods were a mess. I stayed for the appointment and cried as soon as I reached my car.I really wish I had reported this man to the board of medicine. I have never been so insulted by anyone ever in my whole life. I didn't have time to locate a new doctor since I was a new mom and was soon returning to work. I had to endure this man until I could find someone else who was accepting new patients.I am so glad that I will never see that awful man ever again.