Patient Prep Card
Be Prepared
Fill in this card and bring it to your visit.
Today I want to talk about…
1. _____________________________________________________________________________
2. _____________________________________________________________________________
3. _____________________________________________________________________________
My questions are…
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
My health goals are…
_____________________________________________________________________________
_____________________________________________________________________________
Your next appointment is
Mon. Tue. Wed. Thur. Fri. Sat.
Date: _______________________
at: _______________ AM[ ] PM[ ]
