07463 639137

QUESTIONNAIRE

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Welcome to the UK-Oncology.com Medical Questionnaire

Thank you for completing this questionnaire, which is designed to find out a little about you and your recent and past medical history.  In order to give you the most comprehensive opinion on your cancer and potential treatment we need to get as much information as possible.  It helps us to understand how any treatment may affect you and your family. You do not need to answer each question perfectly but the more information the better for our consultant’s assessment of your case.

Your answers are confidential and will not be shared with anyone without your permission .You will be able to discuss your answers with any consultant assigned to your case.  UK-Oncology.com will save your questionnaire securely and it will be encrypted if sent electronically. 

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PAST SURGICAL/MEDICAL HISTORY

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SOCIAL INFORMATION AND LIFESTYLE

 

IF YOU HAVE CHILDREN, CAN YOU TELL US ABOUT THEM?

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FEMALE REPRODUCTIVE HISTORY (PLEASE IGNORE IF MALE)

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FAMILY MEDICAL HISTORY

THE END

Thank you for completing this questionnaire.

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About Us

All specialists featured on UK-Oncology have given permission for their profiles to be listed on the site. We are increasing the number of specialists on our website as fast as we can.

Contact Us

info@uk-oncology.com
07463 639137