Assessment Forms

You may need help keeping all your health history organized. We have created tools that can capture all of your information so you are armed with the necessary information to help your doctor help you.

My Health Records
A comprehensive form that details your entire health history from your health care professionals and family medical history to your surgeries, hospitalizations, medications, allergies, immunizations and so much more. Once you fill out this form, all the relevant information you need at future doctor visits will be right at your fingertips.
Download My Health Records here.

Sarcoidosis Follow Up
This form gives you the opportunity to write down important information about your health since your last doctor visit, including questions you may have. There's no guessing or trying to remember what you had to tell or ask your doctor if you write it down prior to your appointment.
Download Sarcoidosis Follow-Up here.

Patient Anxiety Questionnaire
A tool you can use to track your anxiety.
Download Patient Anxiety Questionnaire here.

These forms provided by the Life & Breath Foundation should only be used as a tool to help you keep track of your health care. Be sure to seek professional help for all aspects of your health care.