
Get the free Seeking a Second Opinion - American Cancer Society
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MEDICAL HISTORY FORM
Patient Name:Age:D.O.B.:Please share with us the reason for your visit:
Which doctor referred you?
PAST MEDICAL HISTORYCancerBRCA tested Cancer Breast Cancer Cervical Cancer Colon
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How to fill out seeking a second opinion

How to fill out seeking a second opinion
01
Research and identify a qualified healthcare professional or specialist in the specific field you are seeking a second opinion for.
02
Gather all relevant medical records, test results, and any other documentation related to your current diagnosis or condition.
03
Compile a list of specific questions or concerns that you would like addressed during the second opinion consultation.
04
Contact the chosen healthcare professional or specialist and schedule an appointment for a second opinion.
05
Bring all the relevant documentation to the appointment and be prepared to discuss your medical history and current diagnosis.
06
During the consultation, ask the prepared questions and express any concerns or doubts you have about the initial diagnosis or treatment plan.
07
Take notes during the consultation to help you remember important details or recommendations provided by the second opinion provider.
08
After the consultation, carefully review the second opinion and compare it with the initial diagnosis or treatment plan.
09
Consider the recommendations and information provided by both healthcare professionals before making a decision about your next steps in the medical process.
10
If you have any further doubts or questions, seek clarification from the second opinion provider or consult additional healthcare professionals if necessary.
Who needs seeking a second opinion?
01
Individuals facing a complex or serious medical condition that requires a careful evaluation before starting a treatment.
02
Patients who have received a diagnosis or treatment plan that they are unsure about or uncomfortable with.
03
People who have experienced limited improvement or worsening of their condition despite previous medical interventions.
04
Individuals considering elective surgeries or invasive procedures who want to explore all available options.
05
Patients who want to ensure they have explored all potential diagnosis possibilities and have the most accurate information about their condition.
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What is seeking a second opinion?
Seeking a second opinion refers to the process of obtaining a professional evaluation or diagnosis from another qualified medical or legal expert to confirm or challenge the original opinion.
Who is required to file seeking a second opinion?
Individuals who receive a diagnosis or medical recommendation that they are uncertain about or wish to verify can seek a second opinion. This typically includes patients dealing with serious health conditions.
How to fill out seeking a second opinion?
To fill out a request for a second opinion, an individual usually needs to provide personal information, details about the original diagnosis or treatment recommendations, and any relevant medical history to the new expert.
What is the purpose of seeking a second opinion?
The purpose of seeking a second opinion is to ensure the accuracy of a diagnosis, explore alternative treatment options, and enhance the patient's confidence in their healthcare decisions.
What information must be reported on seeking a second opinion?
Information that must be reported includes the patient's medical history, details of the original diagnosis or opinion, any treatments already undertaken, and the specific questions or concerns the patient has.
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