Medical History Builder

The Medical History Builder is a form that cancer patients can download and is easy to use. This electronic tool can help you put together a summary of your medical history. It helps as you visit other healthcare providers and may mean you won’t have to fill out the same information each time you see a new doctor. Your data is stored on your PC so you can save and update your information when you need to. This will help you keep your medical information updated and easily accessible in one convenient location. You can print and e-mail the data to your doctor.* You can store, update and share your data from your PC as needed.

Click the link on the right to download this form. The form is a PDF so you'll need Adobe Reader, which can be downloaded from the Adobe site for free.

"You don’t have to fill out those forms every time you go to the doctor and they sit there and ask you the same questions over and over and over again.”—Cancer Survivor