Your doctor may want to know about any changes in your life since your last appointment. It is useful to consider what you should say before you see the doctor. The list below can help. Of course, all the things on this list won’t apply at every visit! Make a copy of the blank list so you will always have a clean copy to use. Then take a minute to think about each of these possible topics. You may want to jot down when you first noticed each change. You can use the last column to note any additional information that may be helpful for the doctor to know.
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TOPIC |
DATE |
NOTES |
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Your diet, medication, and lifestyle: |
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Alcohol use |
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Appetite changes |
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Diet / nutrition |
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Medicines |
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Tobacco use |
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Weight changes |
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Your health: |
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Bone / joint pain or stiffness |
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Bowel problems |
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Chest pain |
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Feeling dizzy or lightheaded |
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Headaches |
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Hearing changes |
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Losing urine or feeling wet |
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Recent hospitalizations or emergencies |
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TOPIC |
DATE |
NOTES |
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Shortness of breath |
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Skin changes |
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Vision changes |
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Your thoughts and feelings |
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Feeling lonely or isolated |
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Feeling sad, down, or blue |
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Intimacy or sexual activity |
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Problems with memory or thinking |
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Problems with sleep or changes in sleep patterns |
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Everyday living: |
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Accidents, injuries, or falls |
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Advance directives |
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Daily activities |
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Driving / transportation / mobility |
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Exercise |
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Living situation |
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Other: |
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[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.