Before you fill this out: your doctor has about 12 minutes. Patients who arrive with their priorities written down use those minutes better. Fill this out the night before or in the car. Be honest, especially on the last section.
What I Must Address Today
1
The ONE thing I must cover, even if we run out of time:
Write it before you walk in. Say it first.
What I Have Been Feeling
2
Symptoms, physical, emotional, energy, sleep, food, mood:
Describe it like you would to a close friend, not a form.
3
How long this has been going on / what makes it better or worse:
"What you feel is data. Say it exactly as you experience it. 'I feel exhausted every day by 2pm' is a clinical observation. Your doctor needs to hear it in your words."
My Questions for Today
What I'm afraid to ask, ask it anyway:
The question you keep putting off is usually the most important one.
Research I Want to Discuss
Article or study I found (PubMed, NIH, or peer-reviewed journal):
The point I want my doctor's perspective on:
Best sources: pubmed.ncbi.nlm.nih.gov · nih.gov · peer-reviewed journals. Bring the title and author. Frame it as a question: "I found this, what do you think?"
