My Family History - MyHealthRecord - BecomeHealthyNow.com

Gathering a complete and accurate family medical history is becoming more important as genetic medicine explains more diseases. As a patient realizes the connection within their family, he or she undoubtedly seeks to gather, perhaps informally perhaps not, more personal information regarding risk to develop particular diseases.

Because many diseases have a hereditary component, a family history of high blood pressure, diabetes, some cancers and certain psychiatric disorders significantly increases your chances of developing the same condition. But whether you'll actually end up with these conditions also depends on your health habits, such as diet and exercise. Knowing now that you're at risk of certain diseases can motivate you to change any unhealthy behaviors.

Heredity is linked to thousands of diseases and conditions. Some diseases and conditions possibly related to your family history include:

Heart disease
High blood pressure
Stroke
Certain cancers, including breast, colorectal, ovarian and prostate
Diabetes
Alzheimer's disease
Parkinson's disease
Huntington's disease

Down syndrome
Cystic fibrosis
Sickle cell anemia
Polycystic kidney disease (PKD)
Eye diseases, including glaucoma and cataracts
Hearing loss
Depression and other psychiatric illnesses

My Family History


Have You or Any Blood Relative Ever Had?

Below is a table of conditions that you, yourself, or blood relatives may have had or presently have. Check the boxes that indicate those conditions that family member NOW HAVE or HAVE HAD in the past. If there is no history of the condition check the box "None". You must check the "None" box if the condition is not in your family history before saving the page.


Which of the Above People Would Accept Help For Their Condition?

Regarding the people that you checked above, which family members do you feel would be most open to receiving help for their condition? We'll contact them for a no-obligation telephone consultation.


Sister	Her Name:	Father	His Name:
	Her Phone: - -		His Phone: - -
	Her Email:		His Email:
Brother	His Name:	Mother's Side	His/Her Name:
	His Phone: - -		His/Her Phone: - -
	His Email:		His/Her Email:
Mother	Her Name:	Father's Side	His/Her Name:
	Her Phone: - -		His/Her Phone: - -
	Her Email:		His/Her Email:

Please review this form to be sure you have answered the appropriate items and that your answers are accurate. Thank you for choosing BecomeHealthyNow.com. We look forward to helping you achieve your your health goals.

If you have registered as an on-line client, the next step will take you to your major health complaint. Once you enter information about your major health complaint, you will continue entering information regarding up to five health complaints.

Please Note:

You have already completed this sub-section of the MyHealth Analysis questionnaire. Your answers are recorded above for you to review. If any of the data in the form is NOT correct and you need to CHANGE your answers, click the appropriate button below. You will then be allowed to make any necessary changes.

Please Note This Section is Complete:

You have already completed this entire section of the MyHealth Analysis questionnaire. Your answers are recorded above for you to review. If any of the data in this subsection or any other subsection is NOT correct and you need to CHANGE your answers, call your on-line doctor, {doc_name} at {doc_phone}. He will make this entire section incomplete and you will be able to make changes to any sub-section. Your previous answers will NOT be lost, and you will be able to review each sub-section and make changes.