NDPH
Free to print
Make the most of a short appointment.
Fifteen minutes goes quickly, and it is easy to forget the question you came with or what the doctor said on the way out. Fill in the top half before you go; write the plan in the bottom half while you are there.
One page, portrait, A4 or US Letter. Print a fresh one for every appointment.
Appointment plannerTop half before the visit · bottom half during it
Name Date
Doctor / clinic Last visit
1. Since my last visit
Overall I am: better about the same worse Main change:
New or different symptoms:
Medicines started, stopped or changed:
Side effects: Urgent care or ER visits:
2. My numbers — from my calendar or diary
| Month | Headache-free days | Severe days | Painkiller days | Days missed (work, school, plans) |
|---|---|---|---|---|
3. My three most important questions — ask these first
1
2
3
4. Other questions worth asking — tick the ones you want to ask
- How sure are we about the diagnosis?
- Is there anything else we should rule out?
- How long should I try this treatment before deciding?
- What is the next step if it doesn’t work?
- How many days a month can I safely take painkillers?
- What should I do on a very bad day?
- Which symptoms mean I should go to the emergency department?
- Would a headache specialist or a headache clinic help?
- Could physiotherapy, psychology or a sleep assessment help?
- Is there a clinical trial I could join?
- Can you write a letter for my work or school?
- When should I come back?
5. The plan — write it down before you leave
| New or changed medicine | Dose | How and when to take it | For how long · when to review |
|---|---|---|---|
Tests ordered:
Referrals:
Other advice:
Next appointment:
Who to contact between visits:
Free from ndph.org · bring your headache calendar and history tooNot a diagnostic tool
Tips for the appointment
- Lead with your top three. Say at the start that you have three questions, so there is time for them.
- Bring numbers, not adjectives. “Twelve severe days last month, painkillers on nine” tells a doctor more than “it’s been really bad”. The year calendar makes this easy.
- First visit with someone new? Bring the two-page headache history too.
- Trying a new preventive? Leave with a trial tracker and an agreed review date.
- Bring someone if you can. A second person remembers what you don’t, especially on a high-pain day.
- Ask for anything unclear in writing, or ask if you can record the key part of the conversation.