testlub

This letter is for your: Dr.Nurse

Enter your Health-care professional full name.

Select your Diagnostic LeukemiaLymphomaBreast cancerProstate cancerColorectal cancerOvarian cancerEndometrial cancerKidney cancerPancreatic cancerStomach cancerHead and neck cancerBone cancerBrain tumorMelanomaOther

Please specify

Enter how many years or months ago your diagnostic was given Enter how old were you when the diagnostic was given

I was treated with ChemotherapyRadiation therapySurgeryImmunotherapyHormone therapyTargeted biologic therapyBone marrow transplantOtherI do not know what treatments I hadI know the basic treatment I received, but I do not know the details

Enter how many years ago the treatment ended

Select one intro statement. —Please choose an option—I would like to discussI am wondering aboutI am concerned aboutI am interested inI would like to knowI need to knowI want to talk with you about Content statements: —Please choose an option—my cancer history with youthe treatments I receivedhow my past treatments may affect my future healthwhat I need to know about my past treatment in order to stay healthy in the futurewhat I can do to be as healthy as possiblewhether I need special tests (blood tests, other screening or surveillance) because of my cancer history Closing statements: —Please choose an option—Thank you for helping me with thisI look forward to seeing you at our next appointmentThank you! Submit