Collecting My Family History of Cancer

Cancer is usually caused by a combination of many factors such as the environment, lifestyle, and other changes that happen to our genes over time. Sometimes, certain cancers may run in families due to changes to our genes that can be passed down between generations. Knowing your family history of cancer can help your healthcare team understand if you might have a higher risk of developing certain cancers.

Use this form to collect information about your family's history of cancer and then share it with your healthcare provider. If you have more family members to include, you can simply print extra copies of the form! As you work on filling out your own form, take time to talk with your loved ones about family history and encourage them to complete their own.

Download a printable copy