American Chronic Pain Association
Date of Visit: _____________
Preparing For Your Health Care Visit It is important to make the most of your visit with your health care provider. One way to do that is to have a brief description of what has taken place since your last visit. To help, just ďŹ ll out this summary before your next visit. Before you go to the health care provider, write down exactly what you think is wrong.
Also include the following: New symptoms since last visit:
What has improved since the last visit?
Questions you have
If possible, take someone with you! Page 1
ŠACPA 2012