Introduction Form

You can print out this form to help you write down information:

• It may be helpful to have a family member or friend go with you to doctors' appointments or to therapy appointments. Having someone go with you can make the visits less stressful and can help you remember what the doctor tells you. On the other hand, you may prefer to be by yourself when you receive information. The choice is yours.

  People I might like to go with me to appointments:

  _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

• Take notes during the visit and/or take a tape recorder with you. Be sure to ask your doctor in advance if it okay for you to tape the conversation. Explain to your doctor that it would help you to understand better and to follow her or his advice.

  Doctors visits I would like to tape record:

  _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

• Ask for an explanation of words that you do not know. (Or, check the Glossary in this section.) As a new word is mentioned, write it down.

  Words I don't understand:

  _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

• If you want more information, ask how you can get it. Your nurse or doctor can tell you about pamphlets, books, videotapes or other things that can help you understand the procedure or treatment he or she is explaining. Your public library, medical library (at a local college or university), or local video store may be good sources of information. The Cancer Information area on this Web site is a good reference point. Maybe you really don't want to know more, but would feel better if a member of your family or a friend know the information. Work this out with that person ahead of time.

  Information that I would like to have and where I can find it:

  _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

• Repeat to the healthcare provider what you thought she or he said. This will let that person know what you heard. Then, if needed, she or he can clear up any confusion.

  Things that I would like to remember to ask about at my next visit:

  _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

• Sometimes the people who are most helpful are those who have been through a similar experience. Ask your doctor or nurse for the names and phone numbers of people who have the same type of cancer that you have and who have agreed that they would be willing to visit with other patients like you.

  Names and phone numbers of people who have the same type of cancer that I have and are willing to speak with me:

  _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

   

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