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Free Printable Doctor Visit Prep Sheet

Your top questions, what has changed, and what helps your child at the doctor, ready before the visit, with room for what the doctor said.

What you type stays on your phone.

How to use it
  1. A few days before, write your top questions and what has changed since the last visit.
  2. Tick what helps your child at the doctor's, and show it to the front desk or the nurse when you arrive.
  3. During the visit, write what the doctor said and the next steps, so nothing is lost on the drive home.

An example, filled in

Example child Filled in for Auren, an example child. Your copy starts blank.
Doctor Visit Prep SheetBefore the visit: questions and changes. During it: what the doctor said.CHILDAurenDATENov 3DOCTORDr. LopezREASON FOR THE VISITYearly check-upMy top questions1.Auren wakes up at 2 am most nights. What can we try?2.Is the picky eating something to watch?3.What has changed since the last visitSLEEPWaking at 2 am, 4 nights a weekEATINGFewer foods than in the summerANYTHING ELSE (SCHOOL, MOOD, THE BATHROOM)Started a new class in SeptemberWhat helps my child at the doctorFirst or last appointment of the dayWait somewhere quietTell my child each step before it happensHeadphonesA favorite toyShow the tools firstOther:Count down from 10 before each stepWHAT THE DOCTOR SAIDTry a bedtime routine chart for 4 weeks.NEXT STEPSCall back in a month if no change.Add this to your child's Bloom Autism Support: snap a photo and send it to your child's Bloom Autism Support email address.Made with Bloom Autism Support · bloomautismsupport.com/freetools
Why it helps

Visits are short and busy, and a hard waiting room can use up everyone's energy before the doctor even comes in. A page ready in advance helps you ask what matters and leave with clear next steps.

Version

Add this to your child's Bloom Autism Support: snap a photo and send it to your child's Bloom Autism Support email address.

More like this

First-Then BoardFirst the task, then what comes next. Daily Log: Sleep, Food and ToiletSleep, food and toilet, one week. Sensory Diet KitActivities, a daily plan and a log.

Made by autism parents with 10 years in special education and ABA.

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