Medical Family Tree
Prepared by Sheila Axtman Kokkeler for the Axtman Family Reunion,
Rugby, ND, July, 1999
Of the 10,000 diseases known to medicine, at least 3,000 are genetic
imprints (inherited). It is for this reason, doctors are always
asking what diseases or conditions run in the family. When one has
an extended and large family, it is difficult to know the answers.
That is why we are putting together a family medical tree and asking
you to share any pertinent information with us by filling out this
form. It is strictly voluntary. We will compile all the information
received and share it with any family member who requests it.
Feel free to include and elaborate on any other condition which
may not be listed on this form. We did not have anything to use
as a guide. It is important to remember that we share 50% of the
genes of our parents and siblings and 25% of the genes our aunts,
uncles, and grandparents.
Name:_______________________ Send me a copy of compiled history:__________
List any members of your family (parents, brothers/sisters, children)
who are deceased and what the cause of death was.
Members of your immediate family and their afflictions/disease/surgeries.
If there's diabetes or arthritis be sure to specify if it was early
or late onset. (Use back if needed.)
High Blood Pressure
Lou Gehrig's Disease
to use any images from the GRHC website may be requested
by contacting Michael