A visit worksheet with questions about medication, device, dose measurement, follow-up, costs and personal goals.
Name:
Appointment date:
Provider:
| Question to discuss | Answer and notes |
|---|---|
| Which medication and device are being considered? | |
| What results and timeline fit my situation? | |
| Which of my current medications should we review? | |
| How is my dose written and measured? | |
| What follow-up schedule is planned? | |
| Which symptoms should I record? | |
| What nutrition and activity goals should I use? | |
| What does the total ongoing cost include? | |
| What should I do if I miss a dose? | |
| What questions remain after this visit? |