Appointment details
Fill in these spaces on the printed version. Do not type sensitive information on the website.
- Professional or team name(fill in this space on the printed version)
- Appointment date(fill in this space on the printed version)
- Appointment time(fill in this space on the printed version)
- Appointment place or format(fill in this space on the printed version)
- Person who will accompany the patient(fill in this space on the printed version)
Before the appointment
- Prepare an updated medication list, including doses and who prescribed them.
- Write down known allergies.
- Describe the changes you have observed, in simple words.
- Note when those changes began and whether they have increased.
- Gather materials or instructions you received previously.
- Write the questions you want to ask, in order of importance.
My questions
- Question 1(fill in this space on the printed version)
- Question 2(fill in this space on the printed version)
- Question 3(fill in this space on the printed version)
During the conversation
- Say what worries you most first.
- Ask to have any unclear instruction repeated.
- Ask who your point of contact will be if something changes.
- Ask which signs to watch for and whom to notify.
- Do not change treatments, dressings or medications without your professional's instruction.
Agreed next steps
- Next step and person responsible(fill in this space on the printed version)
- Next step and person responsible(fill in this space on the printed version)
- Follow-up date(fill in this space on the printed version)
- Treating team phone number(fill in this space on the printed version)
- Another important phone number(fill in this space on the printed version)