epigenetics

DR. OZ’S TRANSFORMATION NATION Million dollar you in partnership with weight watchers.

Family History Worksheet

How to use this worksheet

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

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stroke

Hypertension

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