We hope your bone density measurement experience and teaching session were helpful. 

We hope your experience was a positive one.  Please provide us with any feedback you think would be helpful.



Adult Nurse Practitioner

Osteoporosis Screening and Follow up
Age:                   Race:
Build:  Slender or Normal
Fractures since age 45: Yes or No 
Family history of OP: Yes or No
Current smoking:       PPD
Past:       Pack     Years
Greater than 3 servings of alcohol Yes or No
No. Of  dairy product servings/day:
Calcium/Vitamin D supplement: 
Amount:
Type of exercise/times per week:
Medication: Steroid? Thyroid?  Seizure?
List:

Rheumatoid Arthritis Yes or No
Kidney disease Yes or No
Hip or spine surgery Yes or No
Height now?            At age 25?
Menopause? Yes or No
Year
Hormone replacement? Yes or No
Personal or family history of breast cancer?
Yes or no?  Relationship: