PLEASE PRINT & COMPLETE THIS FORM PRIOR TO YOUR APPOINTMENT.
Prepare for your appointment with a list of questions and concerns. In order to screen for diseases, assess risk of future medical problems, encourage a healthy lifestyle, update vaccinations and medical histories, and maintain a relationship with your doctor, well visits may be scheduled as often as your insurance plan permits. Dr. Bohnstengel will evaluate important behaviors such as smoking, alcohol use, diet, and exercise, as well as any complaints or concerns about your health, and may recommend tests, immunizations, or additional screenings.
PLEASE NOTE DURING YOUR SCHEDULING PHONE CALL THAT YOUR VISIT WILL BE A WELL CHECK.
A WELL VISIT IS NOT YOUR FIRST VISIT DUE TO THE ACCUMULATION OF YOUR MEDICAL HISTORY.
Please review the following recommendations from the U.S. Department of Health & Human Services.
- List your questions and concerns. Before your appointment, make a list of what you want to ask. When you’re in the waiting room, review your list and organize your thoughts. You can share the list with your doctor.
- Describe your symptoms. Say when these problems started. Say how they make you feel. If you know, say what sets them off or triggers them. Say what you’ve done to feel better.
- Give your doctor a list of your medications or, better yet, bring all medications to your office visit. Tell what prescription drugs and over-the-counter medicines, vitamins, herbal products, and other supplements you’re taking.
- Be honest about your diet, physical activity, smoking, alcohol or drug use, and sexual history. Not sharing information with your doctor or nurse can be harmful!
- Describe any allergies to drugs, foods, pollen, or other things. Don’t forget to mention if you are being treated by other doctors, including mental health professionals.
- Talk about sensitive topics. Your doctor has probably heard it before! Don’t leave something out because you’re worried about taking up too much time. Be sure to talk about all of your concerns before you leave.
- If you don’t understand the answers your doctor gives you, ask again.
- Ask questions about any tests and test results. Get instructions on what you need to do to get ready for the test(s). Ask if there are any dangers or side effects. Ask how you can learn the test results. Ask how long it will take to get the results.
- Ask questions about your condition or illness. If you are diagnosed with a condition, ask your doctor how you can learn more about it. What caused it? Is it permanent? What can you do to help yourself feel better? How can it be treated?
- Tell your doctor or nurse if you are pregnant or intend to become pregnant. Some medicines may not be suitable for you. Other medicines should be used with caution if you are pregnant or about to become pregnant.
- Ask your doctor about any treatments he or she recommends. Be sure to ask about all of your options for treatment. Ask how long the treatment is.
- At your annual well visit, discuss any health concerns that you may have, and your physician will work with you on a personal care plan.
- Check with your insurance company, school, or employer to find out if there is any paperwork required to be filled out by the doctor at your well visit, and be sure to bring it to your appointment.