Patient Tool

Appointment Notes Template

You are in charge of making sure you get the most out of your appointment for endometriosis. Use this template to organize your history, symptoms, and goals before meeting with a new specialist. Fill it out, export it as a PDF, and bring it to your appointment. The more detail you can give your doctor up front, the more time you have to talk about solutions and ask them questions. Make sure your doctor gets a copy of this document (digital or paper), and that you keep a copy.

Name

Date of Birth

Medications

List all current medications, dosages, and how long you have been taking them.

Allergies

List any known allergies to medications, materials, or other substances.

Care Team

List the providers currently involved in your care.

Previous Surgeries

List any related procedures you have had, what was found or done, and any concerns you have about how they were handled.

Key Ongoing Symptoms

List all of your symptoms in as much detail as possible. Include when they started, how often they occur, and how they affect your daily life.

Top Concerns

What are your biggest worries going into this appointment? What do you most need addressed?

Treatments Tried

List everything you have tried, what helped, and what did not.

Treatments I Am Not Willing To Try

It is okay to have boundaries around your care. List any treatments you have already ruled out and why.

What I Need From This Appointment

Be specific. What do you need from this doctor? What would make this appointment a success?