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Prepare questions before an appointment and record important information, instructions and clinician-directed medication changes.
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This printable helps you decide what you want to discuss, list information you are bringing and record key points communicated during or after an appointment.
It does not answer medical questions or recommend treatment.
Complete the appointment details and questions before your visit. Bring the records or updates you choose and use the notes area to capture key information in your own words.
Record medication changes only when they were directed by your healthcare professional. If anything is unclear, ask the relevant healthcare professional to explain or confirm it.
Use the matching online appointment planner to add questions and notes, then print the completed record or save it as a PDF.
No. It helps you organize questions to discuss with a qualified healthcare professional.
No. Complete only the sections that apply to your appointment.
Yes. You may use the key-points section to record information and instructions communicated during or after the visit.
Use the clinician-directed medication-change section only for changes directed by your healthcare professional.
Free for personal, non-commercial use. Please do not resell or redistribute the files.
This printable may contain personal health information after you complete it. Store printed copies where you are comfortable keeping them and share them only with people you choose.
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For personal organization only. This worksheet is not medical advice, a diagnostic tool or a substitute for care from a qualified healthcare professional.