Screening Test Checklist

SCREENING TEST CHECKLIST - WOMEN

NOTE: Take this list with you on your next appointment with your doctor or healthcare provider. You can fill it out online and print it, or print it, then fill it in by hand. You may want to print extra copies, as the information you enter will NOT be saved once the window is closed, so as to protect your privacy.

Note: You need javascript to print with this button or close the window; however your browser has apparently disabled javascript. Use the print button on your browser instead, or right click and select the Print option. Once printed, use the X in the upper right corner to close the window.

	type date of LAST test:	type results of LAST test:	type date of NEXT test:
WEIGHT/BMI
CHOLESTEROL - TOTAL
HDL (good)
LDL (bad)
MAMMOGRAM
PAP TEST
OSTEOPOROSIS SCREEN
BLOOD PRESSURE
COLORECTAL CANCER
DIABETES
STDs