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.

Please note: these forms are only for patients who have already been referred to the Allan Blair Cancer Centre or Saskatoon Cancer Centre. 

Privacy and Consent

The information being requested on the form is required to ensure we can properly identify you and meet your needs for care. More details about our information management practices are available at www.saskcancer.ca/privacy. 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 authorized purposes.

We ask that you complete and submit the following forms no more than two days before your first appointment at the cancer centre.

Completing the Forms:

1. Personal Health History 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 personal health history form. To complete the form, you can:

  • Print the form and fill it out by hand; or
  • Fill out the form electronically. Click here for instructions on how to complete the form electronically. 

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.

2. Personal Medication List

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. Click here for instructions to complete the form electronically. 

The form is two pages in length. Please complete all sections as thoroughly and accurately as possible. If your medication review appointment is scheduled over the phone, please have this list with you for any clarification or questions. The completed form does not replace your medication review appointment.  

Submitting the Forms

Once your forms are completed, email them 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 forms, you will receive an automated notification confirming that your forms have been received. NOTE: This email will not respond to inquiries. 

Frequently Asked Questions

Click here for a list of frequently asked questions about completing and submitting the forms.  

 

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