At each visit your doctor will likely ask about your concerns. It’s a good idea to think about what you’d like to talk about before the actual visit. This form can help you organize your thoughts. Make a copy of the blank form so you will always have a clean copy to use. Then, after you make an appointment, take a minute to write down the name of the doctor and the appointment details (for example – the date, the time, the address). Use the form to make a list (in order, from most important to least important) of the concerns you want to discuss.
|
DOCTOR: |
APPT. DATE: |
TIME: |
|
ADDRESS: |
PHONE: |
|
|
APPOINTMENT DETAILS (MOST IMPORTANT TO LEAST IMPORTANT) |
|
|
1 |
|
|
2 |
|
|
3 |
|
|
4 |
|
|
5 |
|
|
6 |
|
|
7 |
|
|
NOTES |
|
[1] Note: This document is meant for the clients of The Law Offices of Jerold E. Rothkoff. Before acting on any information presented here, you are strongly urged to consult with an attorney who is competent in this area of the law.