I finally made myself a doctor’s appointment and before my appointment I had to fill out a questionnaire.
Well! What a great idea Put the patient to work. Have them do some pre-contemplation and goal setting before the visit. Help them feel invested in your time together.
The questions I had to answer included the following:
- How would you rate your current physical health? List specific health problems you are currently experiencing.
- How would you rate your current sleeping habits? List any specific sleep problems you are currently experiencing.
- How many times were week do you exercise? What types of exercise do you participate in?
- Please list any difficulties you experience with your appetite or eating patterns?
- Are you currently experiencing overwhelming sadness or grief?
- Are you currently experiencing anxiety?
- Are you currently experiencing any chronic pain?
- Do you drink alcohol? Drug use? Tobacco?
- Are you currently in a romantic relationship? On a scale of 1-10, how would you rate your relationship?
- What significant life changes or stressful events have you experienced recently?
- List health problems in your family.
- What is your current employment situation?
- Do you enjoy your work? Is there anything stressful about your current work?
- Do you consider yourself spiritual or religious? Describe your faith or belief.
- What do you consider to be some of your strengths?
- What do you consider to be some of your weaknesses?
- What would you like to accomplish out of your time with your physician?
Anything missing? I think I’ll be making up a form to give out to my patients!
{ 2 comments… read them below or add one }
I really like this idea! So smart!
Before my chiropractor appt, his questionairre included, “what the biggest source of stress in your life?”
I though that was a good one!