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Easy Read Doctor Appointment Form

A simplified version of the Doctor Appointment Checklist with straightforward language and clear formatting to help track medical visits.

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Summary

This form is a simplified version of the Doctor Appointment Checklist. It's designed to help you track medical visits. Sections in this form include:

  • Appointment details
  • Your child's details
  • About my child's condition
  • Medicines my child takes now
  • Medicines my child has taken before
  • Allergies
  • Other doctors my child sees
  • Changes I've noticed
  • Questions I want to ask
  • Helpful questions I can ask
  • Notes from today's visit
  • Our next appointment
  • Things to remember
This form is an editable pdf that you can print or share electronically.

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