A conversation, in your own words

Notice it.
Bring it up.

Pick the prompts that make a useful starting point. You do not need to explain the cause, count every episode or complete every question.

This blank sheet is for a conversation with your clinician. It does not assess symptoms or recommend treatment. Keep any notes you add afterward private.

Day observationsWhich activity was interrupted, and what did I have to change?What did I notice during the episode, in my own words?What daytime change would matter most to me?

Night observationsWhen I woke, did I notice heat or sweating, another concern, or no clear reason?Was returning to sleep difficult, and how did I feel the next day?What else about my sleep would I like to discuss?

At the visitWhich medicines and supplements should we review together?How will we assess benefit, side effects and my day-to-day goals?

Your blank question sheet

Take the prompts with you.

0 of 8 prompts selected

Choose any prompts you want to bring to a conversation. There is no score and no recommended number.

Only the fixed prompts are included. This page has no place to enter health details; selections stay in this open page and clear on reload.