Family Health History Record Keeper Tool

As each generation ages, important information can be forgotten or lost – use this worksheet to start a dialogue with your family today to reveal your family’s health history.

• For each blood relative, record all diseases and the age of diagnosis.
• Make copies for your family members.
• Ask family members to share this information with their doctor. Update your family health history on a regular basis and keep it in a
safe place.
• Family gatherings, vacations, holidays and reunions can be good times to collect this information.

This is a tool designed to begin the conversation with your family and health care professional. Knowing your history will help guide your doctor in delivering sound health care.