Doctor Visit Prep Sheet | Her Health, Clearly

1

Visit Information

Date of Appointment

Doctor's Name & Specialty

Primary Reason for Visit

What Do You Want to Walk Away With? A diagnosis? Test results? Treatment plan? Referral? Clarity?

2

Symptom Timeline

When Did Your Symptoms Start?

How Often Do You Experience These Symptoms?

Severity Level (1-10 scale)

1-3 Mild (noticeable but manageable)

4-6 Moderate (interferes with daily life)

7-9 Severe (significantly limits activities)

10 Emergency (unable to function)

Pattern Tracking Does it get better or worse with anything? Time of day? Activities? Food? Stress? Menstrual cycle?

Impact on Daily Life How do these symptoms affect your work, sleep, relationships, or activities?

3

Symptom Details

Check all that apply and add details where relevant

Pain

Bleeding Changes

Energy Levels / Fatigue

Mood Changes

Sleep Disturbances

Digestive Symptoms

Other Symptoms

4

Questions to Ask Your Doctor

💡 Why Questions Matter

Asking questions ensures you understand your health and leaves with a clear plan. Don't worry about "taking up time" — this is YOUR health and YOUR appointment.

What could be causing these symptoms?

What tests do you recommend and why?

What are my treatment options?

What are the risks and benefits of each treatment option?

How long until I should see improvement?

What symptoms should prompt me to come back sooner?

Can I get copies of my test results for my records?

Your Additional Questions

5

Current Health Context

Current Medications Include name, dose, and how long you've been taking it

Supplements & Vitamins

Allergies or Sensitivities

Previous Diagnoses

Recent Life Changes Stress, diet, exercise, weight changes, major life events

Menstrual Cycle Day (if applicable) Day 1 = first day of period. This matters for hormone testing.

6

Visit Notes

Fill this out during or immediately after your appointment

Doctor's Explanation

Diagnosis or Working Diagnosis

Tests Ordered

Prescriptions or Recommendations

Follow-Up Plan

Red Flags to Watch For

7

Self-Advocacy Reminders

You Deserve to Be Heard

It's okay to ask the doctor to slow down and explain things in plain language
Request copies of all test results for your records — you have a legal right to them
If you feel dismissed, try saying: "I need you to help me understand why these symptoms aren't concerning to you"
Bring a support person if that helps you feel heard and remember information
Take notes during the appointment, or ask if you can record the conversation
If your doctor doesn't take your concerns seriously, it's okay to seek a second opinion
Trust your gut — you know your body best