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Consultation preparation form

Fill it in at home, bring it with you to your doctor

At an appointment, a good part of the time goes on questions you could answer far better at home: how many times a day, since when, which medicines, at what dose. Fill in this form at your own pace, generate a one- or two-page PDF and bring it printed. Your doctor gains time, and you do not forget anything you meant to say.

Nothing you write here leaves your device.

There is no server, no account and nothing is sent anywhere. The PDF is generated locally, in your browser. The link to this page is empty — it does not and cannot contain your data, so it is safe to send by any means.

1 Choose where you are
2 Fill in what you know — nothing is required
3 Generate the PDF and print it
1 Where are you in your treatment?

What you choose here only suggests which questionnaires to fill in. You can still tick whichever ones you want.

2 Personal details
cm
kg

3 Your medical situation
4 Weight and eating

Losing weight and losing your appetite are among the most useful things to report before an operation, and the ones most often forgotten at the appointment.

Have you lost weight without meaning to, in the last 3 months?

How much have you eaten in the past week, compared with how you normally eat?

5 Questionnaires

Tick whichever ones fit your situation. Each takes under a minute. If a questionnaire does not apply to you, leave it unticked.

6 What you want to ask

If you are not sure where to start, the Questions for your doctor page has a list you can use as a starting point.

7 Contacts

Related tools

The personal case card is a short summary to carry with you at all times. The journal follows your symptoms day by day and shows how they change in graphs.

Personal case card → Post-operative journal → Surveillance schedule →