Diagnosis Date: __/__/____
Diagnosis: _____________________________ Stage: _____________ Grade: ________________
Additional Information: __________________________________________________
Doctor’s name and contact information:
__________________________________________________
Throughout the course of chemotherapy, what are the warning signs that I should I call you for?
When will this treatment’s effectiveness be assessed?
How should I prepare for chemotherapy?
What would be the exact kind of treatment?
How will the treatment be given (using pills, through injection, or both) and how frequently?
What are the possible next steps after chemotherapy?