follow-up appointment
overview
print this page and fill in the following information 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.
credits
current as of: october 24, 2023
author: healthwise 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, 2023
author: healthwise staff
clinical review board
all healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
