Prepare for Your Visit

🔒 Your answers stay with you. There is no form on this page and nothing is sent to Kitchen Monk. Print it, copy the questions into your phone’s notes, or write on paper. Bring it to your appointment.
🖨️ To print or save as a PDF: on a computer, press Ctrl+P (Windows) or Cmd+P (Mac). On a phone, tap your browser’s Share or ⋮ menu, then Print.

Before your visit

1. What matters most to me today? If I only get to talk about one thing, it is: ______________________
2. What has changed since my last visit? New symptoms, feelings, medicines, supplements, sleep, stress, or life events: ______________________
3. What questions do I have? Write down the top three: ______________________
4. What is getting in the way? Cost, time, energy, transportation, pain, side effects, family responsibilities, or something else: ______________________
5. What have I already tried? What helped, and what didn’t: ______________________
6. What do I want help understanding? A test result, a diagnosis, a medicine, or a plan: ______________________

💊 Bring a list of everything you take: prescriptions, over-the-counter medicines, vitamins, and supplements, with doses. Or bring the bottles.

During your visit

• Start with your most important question, so it doesn’t get squeezed out at the end.
• It’s okay to say, “Can you explain that another way?” or “Can you write that down?”
• Try repeating the plan back in your own words: “So what I’m going to do is…”
• If cost or access is a barrier, say so. Your care team may know of lower-cost options.
• You can bring someone you trust to listen and take notes.

Before you leave

1. What is my main next step? ______________________
2. What should I follow up on, and when? ______________________
3. Who do I contact if I have questions, and how? ______________________
4. What signs mean I should call sooner or get urgent care? ______________________

After your visit: one small step

Pick one thing from your visit that fits your life this week. If you’d like free, practical ideas to go with it, start here, or try something for food, movement, sleep, stress, or connection.

Don’t wait for an appointment in an emergency. In the U.S., call 911 for emergencies, or call or text 988 for a mental-health crisis.

This is a general educational worksheet. It is not monitored by a healthcare professional and does not replace the individualized care plan from your healthcare team. Written by Nathanael Elijah Smith, MSN, APRN, FNP-C, DipACLM, with AI-assisted drafting; independent external review not yet completed. Healthcare offices are welcome to print and share it. Suggestions or corrections: rfjeep@gmail.com.