Doctor Visit Log Sheet

June 23, 2004 - 12:00AM

Print this out and fill in the information.

Name________________________ Date of Birth____________ Age___________

Doctor’s Name____________________________ Date of visit_________________________

Specialty__________________________________________________________________________

Reason for visit, symptoms, concerns, and questions:

1._________________________________________________________________________________

2._________________________________________________________________________________

3._________________________________________________________________________________

4._________________________________________________________________________________

Test results and height, weight, blood pressure, etc.____________________________________

___________________________________________________________________________________

Doctor’s diagnosis and advice_______________________________________________________

___________________________________________________________________________________

List tests to schedule, medication changes, treatment or diet advice and follow-up

appointments

___________________________________ ______________________________________

___________________________________________________________________________________

List tests to schedule, medication changes, treatment or diet advice

and follow-up appointments

___________________________________ ______________________________________

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Reader's comments

I have come to the conclusion that Rt. 70 needs more traffic lights and not less. After living in the area for almost 2 years and witnessing several near misses and one accident on Rt. 70 I believe more traffic signals and perhaps a few jug handles would improve the dangerous situations that exist on this highway.
R. Flynn - Feb 28, 2007 03:00:00 AM	Remove Comment

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