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Printable

Doctor visit checklist

One page to print and fill in by hand before an appointment. It needs no app and no account.

Doctor visit checklist

Print it, fill it in by hand, and take it with you.

Appointment date

Before your appointment

My top three questions ask the most important one first

  1. 1
  2. 2
  3. 3

Medicines and supplements everything you take, including non-prescription medicines, vitamins, and dietary or herbal supplements

One row per thing you take. Write the dose and how often you take it. You can bring the containers instead of the list.
NameDoseHow often

My symptoms, briefly

When it started

How often it happens

How long it lasts

Better or worse since last time

What it stops me doing

Take with me

  • Records my doctor does not already have
  • This sheet, or my list of medicines and supplements

A support person, if I want one

During

  • Ask my top three questions first
  • Say so when an answer is not clear

What I was told

Before I leave

What happens next

How and when I will get any results

Follow-up appointment

  • Written instructions, if there are any

Adapted from public guidance from the National Institute on Aging and the Agency for Healthcare Research and Quality. Not medically reviewed. Published by Off Script Foundry, Inc., which is responsible for it. It does not say which tests or treatments to ask for, and it is not medical advice.

01

How to use it

Print the page and write on it. The lines and boxes on the sheet are drawn, not typed in: there is no field on this page, nothing is saved, and nothing you write is sent anywhere. Printing it sends nothing either.

It prints as one side of one sheet, with the whole of before in the left column and the rest in the right. Fill in what you can before you go and leave the rest blank. A half-filled sheet is still a sheet.

02

Where each line comes from

  • Top three questions. AHRQ asks for exactly three, and the National Institute on Aging says to put your concerns in order and raise the most important ones first.
  • Medicines and supplements. AHRQ lists prescription medicines, non-prescription medicines, vitamins and dietary or herbal supplements. The NIA says to bring a list of everything you take and the dose, or the containers themselves, and its page on what to tell the doctor adds telling the doctor how often you take each one.
  • Symptoms, briefly. The NIA lists what a doctor usually asks: when a symptom started, how often it happens, how long it lasts, whether it is getting better or worse, and whether it stops you doing your usual activities.
  • What to take. The NIA says to take records the doctor does not already have, and that a family member or close friend can come with you to listen and take notes.
  • Before you leave. AHRQ says to find out what to do next and ask for written instructions, to ask questions until the answers are clear, and to find out how you will get any test results and what to do about them.

The guide to preparing for an appointment says the same things at length, with the sources beside each one.

03

What this sheet can and cannot tell you

It can give you an order to work in and somewhere to write things down. That is the whole of it.

  • Not what to ask for. It names no test, scan, referral, treatment, medicine or supplement.
  • Not an interpretation. Nothing on it reads what you write or tells you what it means.
  • Not fibromyalgia-specific. Its three sources are general appointment guidance. None of them is about fibromyalgia.
  • Not a judgement about urgency. It does not say whether anything you write on it is urgent.
04

Sources and corrections

Every line on the sheet paraphrases one of these three pages, each checked on September 17, 2026. Citing them does not mean the National Institute on Aging or the Agency for Healthcare Research and Quality reviewed or endorsed this sheet, Tend, or Off Script Foundry, Inc..

No clinician has reviewed this sheet. To report a mistake on it, email contact@offscriptfoundry.com, and the editorial policy says what happens next.

What this page does not say

  • It does not say which tests, treatments, medicines or supplements to ask for.
  • It does not read, keep or send anything you write on it.
  • It does not say what your symptoms mean, or whether anything is urgent.
  • Its sources are general appointment guidance, not fibromyalgia guidance.
  • No clinician has checked it.

Tend is a self-tracking tool. It is not a medical device, it does not diagnose or treat anything, and it is not a substitute for care from your own doctor. Something wrong on this page? Email contact@offscriptfoundry.com. The editorial policy says how corrections are handled. Off Script Foundry, Inc. is responsible for every statement here.