Patient Decisional Balance Sheet
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1DECISIONAL BALANCE SHEET
Patient name _____________________________ Date completed ___________
What are the benefits/pros of attending
What are the costs/cons of attending
outpatient treatment?
outpatient treatment?
Importance Rating Scale
On a scale of 1 to 10, with 1 meaning not important and 10 meaning
very important, how important is it to you to attend outpatient
treatment?_________
Why not a____? (choose a rating 2 numbers lower and record the
patient’s response)_____________________________________________
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Parent category: Education