Physician Visit Checklist
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1 Physician Visit Checklist How To Get The Most Out Of Your Doctor Visit Condition: Inflammation Symptoms I Am Experiencing: Circle all that apply Constant fatigue High blood pressure Ulcers Leaky gut Irritable Bowel Syndrome (IBS) Bloating Acne Flushing Water retention Food cravings Binge eating Diarrhea or constipation Joint pain Gout Stiffness Unexplainable weight gain Pain in other areas of the body (please specify) Autoimmune conditions Heart disease Depression Anxiety Memory problems Type 2 diabetes Allergies Frequency Of Symptoms Write symptom + frequency you experience it
2 Condition: Inflammation (continued) I Have Treated/Managed By Symptoms By The Following: Explain any medications you have used, lifestyle treatments, natural remedies Family History List any family members/relatives who have had chronic inflammation and related diseases Other Medications I Am Currently Taken Not Related To Inflammation List them here Questions I Have For The Doctor: Question, Notes Do you think my symptoms are due to inflammation? Is inflammation the core problem or is it something else? What do we need to do to make a diagnosis? What can I do right away to begin alleviating symptoms and reducing inflammation? Are there effective natural remedies? How should I change my lifestyle/diet/stress levels to help heal my body? Are there any prescription medications you think I should use? What are the side effects? Are there any more serious underlying conditions you are concerned may be present?
3 Condition: Inflammation (continued) What tests need to happen to rule out other problems? Can you help me create a comprehensive treatment plan so I know exactly what I need to do? Are there any other professionals you recommend I visit? Do you work with a lot of patients who have similar problems? What have you found to be most successful in cases like mine? What symptoms should I consider urgent/a emergency? How long do you estimate I will need to follow the treatment plan before I go back to normal? COPYRIGHT 2018 ASK DR. NANDI AND ASK PARTHA, LLC
4 Physician Visit Checklist How To Get The Most Out Of Your Doctor Visit Condition: Leaky Gut Symptoms I Am Experiencing: Circle all that apply Chronic diarrhea/constipation Frequent gas and bloating Weak immune system (often sick) Headaches Brain fog Memory loss Unexplained fatigue Skin problems (rashes, acne, eczema, rosacea) Frequent cravings for sugar or carbs Joint pain Depression Anxiety Poor focus/add Autoimmune disease Food sensitivities/allergies Inflammatory Bowel Disease Thyroid problems Nutrient malabsorption/nutrient deficiencies Autism spectrum Frequency Of Symptoms Write symptom + frequency you experience it I Have Treated/Managed By Symptoms By The Following: Explain any medications you have used, lifestyle treatments, natural remedies
5 Condition: Inflammation (continued) Family History List any family members/relatives who have or have had leaky gut, IBS, IBD or another digestive disorder Other Medications I Am Currently Taken Not Related To Inflammation List them here Questions I Have For The Doctor: Question, Notes Do you think my symptoms are being caused by leaky gut? Could there be an underlying condition other than leaky gut, such as IBS or IBD? What do we need to do to confirm my diagnosis? Could it be gluten intolerance? How can I tell the difference? What dietary changes do you recommend I try? Are there any effective natural remedies for my symptoms? Are there any medications you recommend? What are their side effects? Are there any supplements you think could be helpful? What is the most effective long-term solution? Do you think there is something in my diet/lifestyle that is aggravating my symptoms? What resources do you recommend so I can become more educated about leaky gut?
6 Condition: Leaky Gut (continued) Do you think complete healing/recovery is possible in my case? How soon should I come back for a follow-up appointment? COPYRIGHT 2018 ASK DR. NANDI AND ASK PARTHA, LLC
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