DR. OZ’S TRANSFORMATION NATION
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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
on set)
stroke
Hypertension
onset)
DR. OZ’S TRANSFORMATION NATION
Family History Worksheet
How to use this worksheet
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