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Talking with Your Doctor

Discussing Your Concerns with the Doctor: Worksheet

At each visit, your doctor will likely ask about your concerns. It’s a good idea to think about what you’d like to talk about before the actual visit. This form can help you organize your thoughts. Make a copy of the blank form so you will always have a clean copy to use. Then, after you make an appointment, take a minute to write down the name of the doctor and the appointment details (for example, the date, time, and address). Use the form to make a list (in order, from most important to least important) of the concerns you want to discuss.

Doctor:
Appt. Date:
Time:
Address:
Phone:
         

Appointment Details (Most Important to Least Important)

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2
3
4
5
6
7
8

Notes: