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Publication #FCS2236

Doctor Appointment Checklist1

Martie Gillen and Carolyn S. Wilken2

As a patient, you will want to make the most of your doctor’s visit. Take a few minutes to answer these questions prior to your doctor’s visit. This will help you remember all that you want to ask and discuss with the doctor. (If you are a caregiver for an older adult, you may also want to review this checklist if you will assist the individual at the doctor’s office.)

Before your appointment, fill in Table 1, Table 2, and Table 3 with any prescription drugs, over-the-counter drugs, or vitamins and supplements that you take on a regular basis. These tables will help the doctors know what medications and supplements you are taking and when you are taking them so the doctor can look for drug interactions and other problems caused by medications and supplements. For example, if you are having trouble sleeping and take a medication in the evening, the doctor might recommend you take it in the morning.

Space for taking notes during your visit is included at the end.

Figure 1. 

It is a good idea to prepare yourself before you visit the doctor. Use this checklist to put together information before and after you visit the doctor so that you are organized and proactive in your medical care.


Credit:

Jupiterimages, © Getty Images


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Date: ___________

What is your primary reason for this appointment? Describe the symptoms or problems you are having?

_____________________________________________________________________________

Is this a new problem or symptom? ________________________________________________

When did you first notice this problem or symptom? ___________________________________

How long does the symptom or problem last? Is it constant or only sometimes?

______________________________________________________________________________

When are the symptoms most noticeable? What treatments have you tried, if any, and have they helped? Describe how this is affecting your daily life.

_____________________________________________________________________________

Notes from This Appointment

Write down any instructions your doctor gives you, any new prescriptions, or any tests your doctor wants you to have.

__________________________________________________________________

Table 1. 

My Prescription Drugs

 

Please enter how many pills you take at each time of day.

Drug and Purpose

(e.g., Drug: Plavix; Purpose: heart, prevents blood clots)

Strength

(e.g., 75 mg)

Breakfast

Lunch

Dinner

Bedtime

Other

Drug name:

Purpose:

           

Drug name:

Purpose:

           

Drug name:

Purpose:

           

Drug name:

Purpose:

           

Drug name:

Purpose:

           

Drug name:

Purpose:

           

Drug name:

Purpose:

           

Drug name:

Purpose:

           

Table 2. 

My Over-the-Counter Drugs

 

Please enter how many pills you take at each time of day.

Drug and Purpose

(e.g., Drug: Ibuprofen; Purpose: arthritis, reduces pain)

Strength

(e.g., 600 mg)

Breakfast

Lunch

Dinner

Bedtime

Other

Drug name:

Purpose:

           

Drug name:

Purpose:

           

Drug name:

Purpose:

           

Drug name:

Purpose:

           

Drug name:

Purpose:

           

Drug name:

Purpose:

           

Drug name:

Purpose:

           

Drug name:

Purpose:

           

Table 3. 

My Vitamins and Supplements

 

Please enter how many pills you take at each time of day.

Name and Purpose

(e.g., Name: Multi-vitamin; Purpose: maintain health)

Strength

(e.g., 600 mg)

Breakfast

Lunch

Dinner

Bedtime

Other

Name:

Purpose:

           

Name:

Purpose:

           

Name:

Purpose:

           

Name:

Purpose:

           

Name:

Purpose:

           

Name:

Purpose:

           

Name:

Purpose:

           

Name:

Purpose:

           

Footnotes

1.

This document is FCS2236, one of a series of the Department of Family, Youth and Community Sciences, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date June 2005. Revised August 2012. Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Please visit the EDIS website at http://edis.ifas.ufl.edu.

2.

Martie Gillen, assistant professor and Family and Consumer Economics for Older Adults specialist, Department of Family, Youth and Community Sciences, and Carolyn S. Wilken, emeritus associate professor, Department of Family, Youth and Community Sciences; Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL 32611.


The Institute of Food and Agricultural Sciences (IFAS) is an Equal Opportunity Institution authorized to provide research, educational information and other services only to individuals and institutions that function with non-discrimination with respect to race, creed, color, religion, age, disability, sex, sexual orientation, marital status, national origin, political opinions or affiliations. For more information on obtaining other UF/IFAS Extension publications, contact your county's UF/IFAS Extension office.

U.S. Department of Agriculture, UF/IFAS Extension Service, University of Florida, IFAS, Florida A & M University Cooperative Extension Program, and Boards of County Commissioners Cooperating. Nick T. Place, dean for UF/IFAS Extension.