Easy To Read Informational Form To Give To Your Doctor!

Doctor sitting behind desk typing on a laptop

When visiting a healthcare provider, sometimes they ask a series of questions (over the phone or in person) that require you to scramble around for needed information.

Here are some typical questions:

  • Do you have allergies?
  • Are you on any prescriptions?
  • Who is your insurance carrier?
  • What’s your diet like?
  • Do you drink or smoke?

After answering the same questions time after time, I decided to create an informational form that I could populate and refer to as needed.

I also shared it with different providers to keep for their files.

The informational form includes the below:

  • Medical Providers Names
  • Insurance Information
  • Allergy Information
  • Supplement Information
  • Prescription Information
  • Surgery Dates
  • Typical Exercise Information
  • Typical Diet Information
  • Lifestyle Information

The doctors found the form incredibly helpful and appreciated having it all in one place.

This can also help if you are a caretaker.

Yes, it takes a couple minutes to complete, but it’s nice to have it in a pinch.

By clicking the following links, you can download a larger 3 page printable PDF version of the informational form.

You can also download and print the Excel version of the informational form and save to your computer!

Once complete, print a copy for your doctor.

Did you find this informational form helpful?  Please leave a comment!

TOPIC: Easy To Read Informational Form To Give To Your Doctor!

 

 

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