Doctor'S Appointment Reminder Sheet Template
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1
2Reminder Sheet for a Doctor Visit
This form may help you prepare for a visit with your doctor. Use it to help you remember
all those questions you have been thinking about since your last appointment. If this will
be a first visit, jot down information your new doctor should have, as well as any
concerns you want to discuss.
Date of Appointment _______________________________________________
Doctor’s Name and Address: ________________________________________
________________________________________________________________
Reason for this doctor visit
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Questions to ask and/or concerns
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Follow-up needed – treatment – what to expect
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
NEXT APPOINTMENT Date: ____/____/______
Time: ________________
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Parent category: Life