Get Follow-up Patient Questionnaire - Evergreenhealth

Filling out the Follow-up Patient Questionnaire is an essential step in ensuring your healing process is well-supported. This guide provides step-by-step instructions on how to complete the form effectively, aiding both patients and healthcare providers in maintaining accurate medical records.

Follow the steps to complete the Follow-up Patient Questionnaire.

1. Click ‘Get Form’ button to obtain the questionnaire and open it for editing.
2. Begin by filling in the appointment date and your full name at the top of the form.
3. Provide the name of your primary care doctor to ensure proper coordination of care.
4. In the section for the reason for your clinic visit, list up to four key issues you would like assistance with during your visit.
5. Indicate any allergies, including medications and other substances that may cause adverse reactions.
6. Detail any new medical problems or surgeries that have occurred since your last visit, ensuring to be as comprehensive as possible.
7. Note any medication changes since your last consultation, which is critical for your ongoing care.
8. Answer questions about pain, including its location and severity, to help assess your current health condition.
9. Respond to questions regarding falls and safety concerns to aid in risk assessment.
10. Evaluate your daily living activities and indicate any difficulties faced in specific tasks.
11. Describe your use of adaptive equipment to ensure that your needs are properly understood and met.
12. Address any swallowing difficulties and current dietary restrictions you may have.
13. Confirm your driving status and mention any concerns raised by family members.
14. Acknowledge any emotional challenges related to your current function levels.
15. Identify any additional services you are currently receiving that may impact your care.
16. Finally, complete the signature section, and if applicable, provide your relationship to the patient if you are not the patient themselves. Once completed, save changes, print, download, or share the completed form as necessary.

Take the next step in your care by completing the Follow-up Patient Questionnaire online today.