Before Your First Visit - Forms to Complete

before your first visit 1At the Saskatchewan Cancer Agency, your health and safety are our priority. To help us plan your cancer care, we require certain information about you including your medical, family and social history.

Privacy and Consent

We only ask for and retain the information required to ensure we can properly identify you and meet your needs for care. By downloading, completing and submitting the health history form, you agree to the collection, use and disclosure of your personal health information by the Saskatchewan Cancer Agency for these purposes. More details about our information management practices are available at www.saskcancer.ca/privacy.

Personal Health History Form

Completing the Form

We ask that you complete and submit the personal health history form prior to your first visit to the cancer centre. Click here to download the health history form.

To complete the form, you can:

  • Print the form and fill it out by hand; or
  • fill out the form electronically. To make the form a fillable PDF, save it to your computer (we do not recommend saving the form on a public computer). You will require Adobe Acrobat Reader DC. Adobe can be downloaded free at https://acrobat.adobe.com/ca/en/acrobat/pdf-reader.html

This form is three pages in length and will take approximately 15-30 minutes to complete. Please complete all sections as thoroughly and accurately as possible. If information is missing, we may need to call you in advance of your appointment to follow up. Your care team will review all of the information that you have provided at the time of your appointment.

Submitting the Form

Once your form is complete, email it to This email address is being protected from spambots. You need JavaScript enabled to view it.. Please include your town/city in the subject line of the email. After emailing the form, you will receive an automated notification confirming that your form has been received. NOTE…this email will not respond to inquiries.

For general inquiries, email This email address is being protected from spambots. You need JavaScript enabled to view it.. While we make reasonable efforts to safeguard your personal information once we receive it, no transmission of data over the Internet or any other public network can be guaranteed to be 100 per cent secure.

Personal Medication List

Please fill out the personal medication list no more than 2 days prior to your first appointment.

Completing the Form

Click here to download the personal medication list.

To complete the form, you can:

  • Print the form and fill it out by hand; or
  • Fill out the form electronically (see directions above).

Bring your completed form along with all your supplements, herbals, and vitamin bottles with you to your first appointment. Do not email this form.

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