Prepare for your appointment by filling in the information below. Then during your visit, write down recommendations your PCP has about the topics and treatment options.

Annual labs

Ask your doctor if there are any labs you need, such as an A1c test or other blood tests.

Care team

List any specialists or other providers you see. This will help your PCP coordinate your overall care.



Write down the prescriptions, over-the-counter medications, supplements and vitamins you’re taking or having difficulty taking. Ask:

  • Am I taking these correctly?
  • Are there any side effects?
  • Are there lower-cost options?


Mental health

Discuss your mental health with your PCP. Let your PCP know if youʼre feeling sad or blue or having difficulty sleeping. Or, talk about challenges you’re having with planning or with memory loss that disrupt daily life.


Tests and treatments

Discuss tests ordered during your appointment. Ask:

  • When can I expect results?
  • Will I receive a follow-up call?
  • Do I need a follow-up appointment?


Physical health

Discuss your physical health with your PCP, including if youʼre having pain that interferes with your regular activities, work or social life.


Health evaluations

Risk of falls

  • I have had a fall
  • I have problems with balancing or walking
  • I don’t have problems with balancing or falling

Bladder control

  • I have problems with bladder control
  • I have problems with leaking of urine
  • I don’t have bladder control or urine leakage problems

Physical activity

  • Start exercising
  • Increase exercise
  • Maintain current exercise level

Other health concerns