Medical Details

Details

Medical Details/History

Have you had a previous diagnosis of cancer?

 

Do you have heart issues?

 

If yes, please check:

 

Do you have lung or breathing problems?

 

Have you had any neurological problems? (eg. Stroke or seizure)

 

Do you have diabetes?

 

If yes, which type of current treatment:

 

Do you have high blood pressure?

 

Have you ever had any blood clots in your legs or lungs?

 

Do you have any autoimmune illnesses?

 

Do you have a blood or bleeding disorder?

 

Are you, or could you be pregnant?

 

Are you currently breastfeeding?

 

Have you had any of the following:

 

Do you smoke or have you ever smoked?

 

If yes, specify (approximately):

Do you drink alcohol?

 

Have been exposed to hazardous substances? (eg. asbestos, benzene etc.)

 

Your mobility:

 

Medications

Do you take any regular medication? (including herbal, or over the counter medications)

Allergies

Do you have any allergies or sensitivities to any medications, latex, food or other:

Family History

Do you have any family history of cancer?

 

If yes, specify

Past Surgery

Enter any previous operations you have had:

Harbour Cancer & Wellness provides essential health services at all COVID-19 alert levels.

We are very focused on providing a safe environment for patients in our facilities: Clinic, Day-Stay and in the Wellness Centre.

To discuss a referral or treatment, call our main line on 09 220 3333.

Wellness services are available at Level 3 - phone DDI: 09 925 4451 / email wellness@harbourcancer.co.nz


Take care, everyone

Harbour Cancer & Wellness team