Lung Cancer Form

You can print out this form to help you answer the questions

Members of my family and others close to me who have the same kind of cancer I have.:

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That person's experience with lung cancer and how it affected me or how I felt about it:

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The symptoms I have:

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The type of lung cancer I have:
(If you don't know, ask your doctor or nurse and have them write it down for you).

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The following are the tests I have had and the results of those tests:

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The results of my biopsy:

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The result of my sputum cytology:

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