Doctor's name:_________________________________ Date of interview:___________________________________ Doctor's specialty:_______________________________ Referred by:_______________________________________
What experience and success have you had treating my type and stage of cancer?
Which medical facilities(or hospitals) would you use for my treatments?
What treatment methods do you think are best for my type and stage of cancer?
Would a clinical trial or new treatment in development be right for my situation?
Where can I find good information about these types of treatments?
What side effects or risks are possible with each type of treatment?
Is there anything that can be done to lessen the possibility of having side effects?
Can you tell me about some successes you have had with you patients and this type of cancer treatment in the past?
Can you help me meet with another cancer survivor about his or her experience with this type of cancer?
can you tell me about other doctors and healthcare team members who would be involved in my care and their roles in my treatment?
Who would manage the care of any pain problems, and how would that be done?
Would you consider referring me for complementary or alternative treatments, such as acupuncture, massage or nutritional assistance?