Health & Beauty News & Information for Men & Women
 

Personal Prevention Chart

Use this Personal Prevention Chart to keep track of the preventive care that you
have received and/or will need in the future. With the help of your health care
provider, fill in how often you need each type of preventive care. Write in the date 
and results of tests each time you receive preventive care.
Type of Care    How Often     Goal     Dates      Results

(Example)

Blood pressure  Once a month  130/70   03/03/2004  140/80  _______  _______ 


Blood pressure   __________   _______  _________   _______ _______  _______  


Cholesterol      __________   _______  _________   _______  ______  _______
 
Weight          __________    _______  _______    _______   _______ _______ 
Healthy weight for me: __________ Check here
Dental Visits    ____________   _______  _______  _______   _______  _______  
Vision           ____________   _______  _______  _______   _______  _______


Return to Regular Checkups: Teeth and Gums, Cholesterol, Oral Cancer
Return to Personal Prevention Charts
Return to Contents of Staying Healthy at 50+

 

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