Questions For My Doctor

Be prepared. Get answers. Take charge of your health.

Family Member:Date of Birth:Primary Doctor / Provider:Phone:Reason for visit:Location / clinic:Date of appointment:Time:

My questionswhat I want to ask	Doctor's answerswhat my doctor said	Recommendations / next steps

Things I need to remember

Medications / dosage changes:Tests / procedures ordered:Referrals / specialists:Lifestyle changes / self-care:When to follow up: