Complete this form if you are seeing this health professional for the first time. Although you may have to complete a similar form when you arrive at the office, completing this form will help you organize your thoughts and provide more complete information. Complete Section 2 at the end of your appointment if you have…
Use this form if your doctor recommends a special treatment, such as radiation or physical therapy. General questions What is the name of the treatment? Why do I need this treatment? What might happen if I delay or avoid this treatment? Are there any other treatment options? If so, describe them: What is the next step…
When you’re facing a tough health care decision, you may have a hard time knowing what to do. Is surgery the answer? Is that expensive test the right choice? Is it best to get treatment, or watch and wait? To answer the big questions, it’s a good idea to talk to more than one doctor. This is called getting a second…
Answer the following questions before and during your appointment to follow up on a health problem. Concerns What health problem is the reason for this return appointment? What questions or concerns do I want addressed during this appointment? Do I have any new symptoms? Yes ___ No ___ If yes, include how long I have…
Print this form and fill in Section 1 before your appointment. Complete section 2 at the end of your appointment if you have a health problem that needs treatment. Section 1 Health information What questions or concerns do I want addressed during this appointment? My symptoms Do I have any symptoms? Include how long…
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