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Medical Form

Your Health Planner

Do you ever leave doctor's appointments feeling like you have more questions than answers? Get overwhelmed during visits and forget what you wanted to focus on? The tools and information on this page will help you collect important information, focus your visits, improving your outcomes!

Instructions and Suggestions

This planner is designed to help you stay organized, prepared, and empowered throughout your healthcare journey. Here’s how to get started:

Update the History Page as Needed

Keep your Health History section up to date with any changes, such as:

  • New diagnoses

  • Changes to medications or dosages

  • New family medical information

  • Surgeries or hospitalizations

  • Changes to your primary care provider or pharmacy

This page doesn’t need to be updated often. Just make sure it reflects your current health status before appointments.

Duplicate the Visit Pages for Each Appointment

Each time you have a doctor’s appointment, use a new set of the following sections:

  • Appointment Prep

  • Appointment Notes

  • Appointment Reflection

  • Follow-Up Plan

You can print extra copies or duplicate the digital pages to create a running log of your visits. This makes it easier to:

  • Track your progress over time

  • Remember what was discussed

  • Prepare better for future appointments

Access Planner to edit in Google Docs or paste into your notes app:

What kinds of conditions should be documented under family history?

It is important for you to know your family history, so doctor's can fully assess your health. This is not an exhaustive list of the conditions your provider may ask you about, but it is a good start. 

Genetic Conditions
  • Cystic fibrosis

  • Sickle cell anemia

  • Thalassemia

  • Hemophilia

  • Muscular dystrophy

  • Huntington’s disease

  • BRCA1/BRCA2 gene mutations (linked to breast/ovarian cancer)

Cancers
  • Breast cancer

  • Ovarian cancer

  • Prostate cancer

  • Colon cancer

  • Melanoma

  • Pancreatic cancer

Respiratory Conditions
  • Asthma

  • Chronic obstructive pulmonary disease (COPD)

  • Cystic fibrosis

Eating Disorders
  • Anorexia nervosa

  • Bulimia

  • Binge eating disorder

Other Conditions
  • Blood disorders (e.g., clotting disorders)

  • Kidney disease

  • Hearing or vision loss (especially early-onset)

  • Alcoholism or substance use disorders

Cardiovascular Conditions
  • Heart disease (especially early-onset)

  • High blood pressure (hypertension)

  • High cholesterol

  • Stroke

  • Aneurysms

Mental Health & Neurological Disorders
  • Depression

  • Anxiety disorders

  • Bipolar disorder

  • Schizophrenia

  • Autism spectrum disorder

  • ADHD

  • Dementia or Alzheimer's disease

  • Parkinson’s disease

  • Epilepsy

Metabolic & Endocrine Disorders
  • Diabetes (Type 1 or Type 2)

  • Thyroid disorders (e.g., hypothyroidism, hyperthyroidism)

  • Obesity

Autoimmune & Rheumatic Diseases
  • Lupus

  • Rheumatoid arthritis

  • Psoriasis

  • Multiple sclerosis

  • Celiac disease

  • Inflammatory bowel disease (Crohn’s, ulcerative colitis)

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