Pre Appointment Questionnaire

Pre Appointment Questionnaire

Time with your Healthcare partner is often very limited. To be your best advocate requires
preparation. Documenting your reasons for the visit, beforehand, will help you receive the
answers you NEED.

Print individual sheets for each visit document and RECORD the answers

  1. Clearly state your reason for the visit.

  1. Give timing of the symptoms. How long have you had?

  1. If pain, state sharp, dull, constant or with certain activities.

  1. Document any changes in your medication or adding any supplements.

  1. Document any related symptoms. Fatigue, dizziness, increased thirst,
    change in bowel habits?

  1. Are you doing anything that changes the symptom? Heat/cold, pain meds?

  1. Have you noticed any other changes, that may or may not be related?

Learning to document and describe should provide you with satisfactory outcomes for better health.
ADVANCE APPOINTMENT PRE-CHECKLIST is for you to document WHY you are there and what you NEED.


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