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Your printable appointment outline

Download the one-page outline, print it, and fill it in on paper. The six prompts are also shown below. No account is needed, and this page does not collect or save notes.

Download printable PDF

1 page · US Letter · PDF

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In your own words

My appointment outline

A place for what matters to you, your questions, and the plan you want to keep.

Main reason for this visit: Blank space to write after printing
What I have noticed and want to discuss: Blank space to write after printing
My first question: Blank space to write after printing
Other questions, if there is time: Blank space to write after printing
The clinician's plan, recorded after the visit: Blank space to write after printing
What I need to clarify or do next: Blank space to write after printing