GUIDE FOR CARE AND SUPPORT DURING SERIOUS ILLNESS

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Chapter 1: Communicating with your doctor: Questions and Answers

Record of Appointments

Appointment date & time:_____________________________________

With:______________________________________________________

For:_______________________________________________________

Location:___________________________________________________

Phone:_____________________________________________________

Questions/Concerns:_________________________________________

Appointment date & time:_____________________________________

With:______________________________________________________

For:_______________________________________________________

Location:___________________________________________________

Phone:_____________________________________________________

Questions/Concerns:_________________________________________

Appointment date & time:_____________________________________

With:______________________________________________________

For:_______________________________________________________

Location:___________________________________________________

Phone:_____________________________________________________

Questions/Concerns:_________________________________________

Appointment date & time:_____________________________________

With:______________________________________________________

For:_______________________________________________________

Location:___________________________________________________

Phone:_____________________________________________________

Questions/Concerns:_________________________________________

Appointment date & time:_____________________________________

With:______________________________________________________

For:_______________________________________________________

Location:___________________________________________________

Phone:_____________________________________________________

Questions/Concerns:_________________________________________

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Next page: Chapter 1: Notes, Questions, Responses, Ideas