Checklist for Communicating with Providers

The Checklist for Communicating with Providers is a list of aliments for you to show your provider. It will help communicate how you are feeling and what others have told you.

Check the boxes that apply – also note if you noticed the symptom or if others told you that it was an issue.

Print and take the form with you to your next appointment and write notes on any recommendations.

Remember to keep this to refer to what was tried, what helped or did not help. It is important to pay attention to what friends or family tell you they are seeing.

If you have any questions or concerns about the Checklist please contact us at: 1 (877) 856-1772 or

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