Mammography Patient History Questionnaire Date 2025

1. Click ‘Get Form’ to open the Mammography Patient History Questionnaire Date in the editor.
2. Begin by entering the date at the top of the form. This helps in tracking your medical history accurately.
3. Fill in your name and date of birth, ensuring that all personal information is correct for proper identification.
4. Indicate the number of pregnancies and age at first pregnancy. This information is crucial for your medical history.
5. Complete the section regarding any breast procedures or surgeries. Check 'Yes' or 'No' and provide details as necessary.
6. Answer questions about family history of breast cancer by marking 'Yes' or 'No' for each relative listed.
7. Provide details on menstrual history, including age at first and last period, and answer questions about current menstruation status.
8. Finally, review all entered information for accuracy before signing and dating the form at the bottom.

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