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Checklist Preparing for Your Doctor's Visit

Checklist Preparing for Your Doctor’s Visit


Here is a checklist preparing for your doctor’s visit. This list was prepared by the Alzheimer’s Association


Fill out the information below to the best of your ability. Share it with your doctor. Be open and honest in answering any questions your doctor may ask you about the changes you’ve been experiencing.

Has your health, memory or mood changed?

How did it change?

When did you first notice the change?

How often does it happen?

When does it happen? Is it always at a certain time of day?

What do you do when it happens?

What behaviors are the same?

Do you have problems with any of the following?


Please check the answer:

Repeating or asking the same thing over and over? ❏ Not at all ❏ Sometimes ❏ Frequently ❏

  • Does not apply Remembering appointments, family occasions, holidays? ❏ Not at all ❏ Sometimes ❏ Frequently ❏ Does not apply
  • Writing checks, paying bills, balancing the checkbook? ❏ Not at all ❏ Sometimes ❏ Frequently ❏ Does not apply
  • Shopping independently (e.g., for clothing or groceries)? ❏ Not at all ❏ Sometimes ❏ Frequently ❏ Does not apply
  • Taking medications according to the instructions? ❏ Not at all ❏ Sometimes ❏ Frequently ❏ Does not apply
  • Getting lost while walking or driving in familiar places? ❏ Not at all ❏ Sometimes ❏ Frequently ❏ Does not apply


Medications and medical history

  • List of medications (dosage, frequency) including over-the-counter and prescription:
  • List vitamins and herbal supplements:
  • List current medical conditions:
  • List past medical conditions:

Questions to ask the doctor

  • What are tests I need to take and how long will it take to get a diagnosis?
  • Will you refer me to a specialist?
  • Could the medicines I’m taking be causing my symptoms?
  • Do I have any other conditions that could be causing my symptoms or making them worse? What should I expect if it is Alzheimer’s?
  • Which treatments are available for Alzheimer’s? What are the risks and benefits and possible side effects? What about participating in a clinical trial? What are the risks and benefits?
  • Is there anything else I should know?
  • When should I come back for another visit?

Applewood Our House has four residential assisted living homes for those with memory care needs.

Applewood Our House has a Better Business Bureau A+ Rating.

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