Integrating Primary Care Practices and Community-based Resources to Manage Obesity

Tool 12. Sample Punch Card

[Clinic Logo] [Clinic Name]

This is how many times I visited:

___________________________________________

(referred resource)

___________________________________________

(Name)



Get a punch for each visit.

A row of apples.

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Page last reviewed May 2014
Internet Citation: Tool 12. Sample Punch Card. May 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/prevention-chronic-care/improve/community/obesity-pcpresources/obpcp-tool12.html