Questions for My Doctor

One page to bring to your appointment. Write what you want to cover and the questions you want to ask. Every box is optional.

Your answers stay on this device until you press Clear. Nothing is sent anywhere.

For any appointment

What I most want to talk aboutIf time is short, this is the one thing to cover first.

What I’ve noticedDescribe one change, when it began, and how it affects daily life.

Medicines and anything else that may be relevantInclude medicines, vitamins and supplements you take.

My questionsType your own, or tap a question to add it.

Questions you can add

After the visit: what we agreed and what happens nextWrite it down before you move on to another task.

Sleep Conversation Notes

(optional)

What I’ve noticedDescribe one change and its effect. Example: “I fall asleep watching television most evenings.”

When it happensWhen did it begin? Is it getting worse? Approximate sleep and waking times are fine.

What others have noticedWhat did they actually observe? If you sleep alone, you can skip this.

What may be relevantMedicines, alcohol or caffeine, pain, other symptoms. Wearable information if you already have it. Its score is not a diagnosis.

What I’ve already tried

My biggest concerns

Questions for my clinicianType your own, or tap a question to add it.

Before a diagnosis

Do not drive when sleepy. Arrange another way to travel if you are struggling to stay awake, and discuss significant daytime sleepiness with a clinician.

If you are already in treatment

These notes are for your conversation with a clinician. They are not a diagnosis.