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The Follow-Up Visit Form is a concise pre-visit questionnaire for return patients. It focuses on changes since the last appointment rather than repeating comprehensive intake questions, making it quick for patients to complete (typically under 3 minutes) while providing clinically valuable pre-visit information.
The form captures treatment progress and effectiveness, symptom changes (improved, worsened, or unchanged), medication updates including new prescriptions from other providers, side effects experienced, and any new concerns or questions the patient wants to discuss. The pain level assessment provides a consistent tracking metric across visits.
This template is ideal for chronic disease management (diabetes, hypertension, pain management), post-procedure follow-up, therapy progress check-ins, and specialist follow-up visits. It can be sent automatically a day before the scheduled appointment, giving providers a preview of the patient's current status before they walk into the exam room.
What's included
- Treatment progress assessment
- Symptom change tracking
- Medication update and side effect reporting
- New concerns and questions for the visit
- Pain level tracking across visits
- Structured medication list with dosage and frequency tracking
Who uses this template
- Chronic disease management follow-ups
- Post-procedure and post-surgical check-ins
- Therapy and counseling progress visits
- Specialist follow-up appointments
All form fields
5 fields across 1 page. Customize any field after signing up.
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