My healthcare visit notes
Print this page and write on it by hand. Keep your notes with you; this site does not receive or save what you write.
Before the visit
My main concern or question
When it started, what changed, and what helps or worsens it
Medicines, supplements, and allergies I want to mention
Questions for the clinician
- What might explain my concern, and would any tests help?
- What options should we discuss, and what should I know about them?
- What should I watch for, and when should I seek urgent care?
- What are my next steps, whom should I contact, and when should I follow up?
Educational worksheet only. For an emergency, call your local emergency number. Independent clinician review of this site is pending.
Visit-preparation resources: MedlinePlus · AHRQ Questions Are the Answer