Salir
Overview
Answer the following questions before and during your appointment to follow up on a health problem.
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 had them and what helps relieve them. If I have pain, describe where it is, how it feels, and how severe it is. |
Have I had any difficulty carrying out my treatment for this condition? Yes ___ No ___ If yes, describe briefly: |
Have I had any recent stresses that may affect my ability to care for the condition I have? Yes ___ No ___ If yes, describe briefly: |
Do I need any special written information or instructions to help me care for the disease or condition I have, such as instructions about monitoring my blood sugar if I have diabetes? Yes ___ No ___ |
Are there any new treatments or tests for this condition? What are the benefits and risks of the new treatments or tests? What could happen if I choose not to have the new treatment or test? |
What signs and symptoms should I watch for? When should I call to report signs and symptoms? |
Check here if no contact is needed. ____ |
Call to find out test results or to report how I am doing: Date: _______ Time: _______ |
Return for an appointment: Date: _______ Time: _______ |
Reminder
Bring all the records you have been keeping since your last visit, such as a blood sugar record if you have diabetes.
Related Information
- Appointment for a New Problem
- First Appointment
- Regular Checkup for a Child
- Regular Checkup for a Lifelong Condition
- Your Family Medical History
Credits
Current as of: October 24, 2024
Author: Ignite Healthwise, LLC Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
Current as of: October 24, 2024
Author: Ignite Healthwise, LLC Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
