Doctor Visit Checklist & Health Assessment Questionnaire
About this tool
Preparing for a doctor appointment can be hard, especially when you are worried about a health problem. It is easy to forget when a symptom started, what makes it worse, which medications you take, or the question you meant to ask.
This health assessment questionnaire helps you organize that information at home. You can answer the questions, review your information, create a Doctor Visit Summary, print or save it, and take it to your appointment.
This tool does not diagnose medical conditions. It is designed to help you organize information and prepare for a conversation with your healthcare professional.
Start My Health Questionnaire
START QUESTIONNAIREHow It Works
- 1. AnswerComplete the questions about your symptoms, health history, medications and concerns.
- 2. ReviewCheck your answers and add anything you may have forgotten.
- 3. Take It With YouGenerate your Doctor Visit Summary and print or save it for your appointment.
Doctor Visit Preparation Questionnaire
Take your time and answer as accurately as you can. You do not need to know medical terminology. Use your own words whenever a question asks you to describe something.
Privacy: Your answers may contain personal health information. Only provide information you are comfortable entering. This questionnaire is designed to help you prepare for a conversation with a healthcare professional. It does not diagnose medical conditions. Answers stay in your browser and are not sent anywhere.
Take Your Summary to Your Appointment
Why Prepare for a Doctor Appointment?
Appointments are often short. Writing down your symptoms, medications and questions beforehand makes it easier to explain what is happening and helps you leave with answers instead of regrets.
What Should You Tell Your Doctor?
Doctors commonly need to know your main concern, when it began, how it has changed, and how it affects daily life. They also ask about past conditions, surgeries, medications, supplements, allergies, family history, and recent changes such as travel, illness, stress or a new medicine. Share anything that worries you, even if it seems unrelated.
What Should You Bring to a Doctor Appointment?
- A current list of medications, vitamins and supplements (or the containers)
- Relevant test results or records from other providers
- Insurance information and identification, if your clinic requires them
- Your written questions and your Doctor Visit Summary
Questions to Ask Your Doctor
- What could be causing my symptoms?
- Which tests do I need, and what will they tell us?
- Could any of my medications be contributing?
- What warning signs should make me seek care sooner?
- When should I follow up?
How to Keep Track of Your Symptoms
Keep a simple note on your phone or on paper. Record the date and time, what you felt, how severe it was from 0 to 10, how long it lasted, and what you were doing beforehand. A week or two of notes often shows patterns that are hard to remember later. For more reading, browse our health and wellness guides.
If you have severe symptoms such as chest pain, trouble breathing, sudden weakness, or confusion, do not use this tool. Seek emergency care immediately.
Health Assessment Questionnaire: Frequently Asked Questions
What is a health assessment questionnaire?
A structured set of questions about your symptoms, medical history, medications and lifestyle. This one helps you organize that information before an appointment. It does not diagnose anything.
What should I write down before seeing a doctor?
Write down your main concern, when symptoms started, how often they happen, how severe they are, what makes them better or worse, your medications and allergies, and your questions.
What questions should I ask my doctor?
Common questions include what could be causing the symptoms, whether tests are needed, whether a medication could be contributing, what warning signs to watch for, and when to follow up.
What medical information should I bring to an appointment?
Bring a medication and supplement list, relevant test results or records, insurance and identification if required, and your written questions.
Should I make a list of my medications?
Yes. Include the name, dose, how often you take it and why. Add vitamins, supplements and over-the-counter products.
Can a questionnaire diagnose a health condition?
No. This questionnaire only organizes the information you enter. Only a qualified healthcare professional can diagnose a condition.
Can I print my doctor visit summary?
Yes. After creating your summary, use the Print button, or choose Save as PDF in your print dialog. You can also save it as a text file.
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