Keeping Your Personal Health Records

Useful Forms for Those With Thoracic Aortic Disease

On this page are forms that those with aortic disease may find helpful in keeping records of their personal health information. 

Clicking on the links below will open each form in PDF format. Individuals are encouraged to print out and use these forms for their personal needs, in accordance with the copyright specfied on each form.

Blood Pressure Record

Diagnosed Medical Conditions

Emergency and Other Contact Information

Family Medical History

Medical History

Medication List

My Physicians

Personal Information

Social History




Contact Us
Bicuspid Aortic Foundation
30100 Town Center Drive, Suite O-299
Laguna Niguel, CA  92677

Telephone
Toll free in the US  (888) 310-HOPE (4673)
or
(949) 495-0027

Fax: (949) 606-0413

Email: contactus@bicuspidfoundation.com

  

Copyright © 2004 - 2006, Bicuspid Aortic Foundation.
All Rights Reserved.

The Bicuspid Aortic Foundation recognizes the importance of maintaining the privacy of individuals who use its web site.

In using the Bicuspid Aortic Foundation web site, you are agreeing to the terms of this privacy policy. If you do not wish to accept the terms of this privacy policy, please do not access the Bicuspid Aortic Foundation web site.

All personal information provided to the Bicuspid Aortic Foundation will be kept confidential within the Foundation, and will not be disclosed to any third party without the permission of the individual.

Email and messages sent through the web site are not secure. Therefore, personal information you transmit to the Bicuspid Aortic Foundation may be intercepted by others and is done at your own risk. 

The Bicuspid Aortic Foundation may contact you regarding topics of interest. If you do not wish to receive such communications, you may contact the Bicuspid Aortic Foundation and indicate that you do not wish to receive them. If at a later time you again wish to receive such information, you may indicate that by contacting the Bicuspid Aortic Foundation.

The Bicuspid Aortic Foundation makes no representation whatsoever regarding the privacy policy of other web sites whose links are on the Bicuspid Foundation web site. Your usage of other web sites is entirely at your own risk. You should carefully read the privacy policies of all web sites that you visit.

Please contact the Bicuspid Aortic Foundation regarding any questions you may have about this policy.



The information on the Bicuspid Aortic Foundation website is provided for general informational purposes only. This information is not professional, legal, or medical advice. Any medications, products, or treatment mentioned are presented as information only and do not constitute any recommendation, approval, or endorsement. Any information is general in nature and is not a substitute for medical care. You should contact a physician or other qualified medical professional for advice about all health-related conditions.

The Bicuspid Aortic Foundation, including its officers, directors, volunteers and any others acting on its behalf, individually and collectively, make no representations or warranties, express or implied, regarding the contents of this website, including its accuracy, completeness, or reliability.

Any links or references to other websites provided on the Bicuspid Aortic Foundation website are made available as a convenience only. The Bicuspid Aortic Foundation has not reviewed all of the websites linked to this website and is not responsible for the content of these sites or your use of them.



Home
Bicuspid Aortic Valve Disease
All aortic aneurysm
     and dissection in the chest
For families and medical professionals,
    by families and medical professionals
Creating a climate of hope, an atmosphere of caring, and a source of information for all who are touched by thoracic aortic disease and the medical professionals who care for them.
  Creating a climate of  hope
BICUSPID  AORTIC  FOUNDATION
Bicuspid Aortic Valve Disease   Thoracic Aortic Aneurysm & Dissection 
 
t.gif