Medical Appointment Brief Template

For the method in Prepare for a Medical Appointment in 20 Minutes. Fill in each section using your own verified facts - use AI only to organize, never to interpret.

Not for

Deciding whether something is urgent, diagnosing a symptom, or changing a medication. If you are unsure whether to wait for this appointment, use an official clinical triage route or contact an appropriately qualified clinician. For immediate danger or signs of an emergency, call your local emergency number instead of filling this in.

Visit basics

• Date of appointment:
• What I want out of this visit, in one sentence:

Timeline (organized, not interpreted)

Effect on everyday function and concerns

• Work, school, sleep, mobility, eating, self-care, or other activities affected:
• What has changed from my usual baseline:
• What worries me most, in my own words:

My priorities, in order

Medication, allergy, and reaction list (verified from current labels or records - not memory)

• Over-the-counter medicines, vitamins, supplements, or non-prescription products not yet listed:
• Allergies and previous adverse reactions:

Access and communication plan

• Interpreter, accessibility, communication, transport, or support-person need:
• Records, devices, readings, or forms I need to bring:

Questions to ask

Notes during the appointment (leave this blank until you’re there)

The three prompts to reuse

Health notes may be sensitive. Prefer an offline tool or approved clinical channel; do not paste identifiable records into an unapproved service.

1. Organize the timeline

Here are my rough notes about a health concern I want to discuss with
my doctor: [paste notes]. Organize this into a short, dated timeline
in plain language. Do not suggest a diagnosis, likely cause, or
urgency level - I only want my own information organized clearly, not
interpreted.

2. Rank priorities

I have [N] things to cover in a [length]-minute appointment: [list
them]. Help me put them in the order I should raise them, assuming I
might only get through the first one or two - based on which ones I
said matter most to me, not on medical seriousness.

3. Format the medication list

Here is my medication list exactly as printed on my labels/pharmacy
records: [paste, exactly as written]. Format this into a clean table:
medication name, dose as printed, and how I actually take it. Do not
change, add, or infer anything I did not give you.

Before you print

• No sentence in the timeline guesses at a cause or urgency level
• Every medication entry came from a label or pharmacy record, not memory
• Over-the-counter medicines, supplements, allergies, and previous adverse reactions are included
• Functional impact and my main concern are written in my own words
• Interpreter, accessibility, and support-person needs are arranged where relevant
• Priorities are ordered by what matters to me, not by a model’s judgment
• Questions are phrased as questions, answerable in a sentence or two