Checklist

Take this checklist with you to your doctor's appointment. Write down when you have any of the tests below. Talk to your doctor about your test results and write them down here. Ask when you should have the test next. Write down the month and year, and try to schedule in advance to not miss milestone appointments. If you think of questions for the doctor, write them down to ask your physician or provider at your next appointment.

CHECK-UP CHECKLIST
Test Last Test (Month/Year) Results Next Test Due (Month/Year) Questions for the Doctor

Weight

       

Cholesterol

       

HDL

       

LDL

       

Blood Pressure

       

Mammogram

       

Pap Smear

       

Colorectal
Cancer

       

Diabetes

       

Sexually
Transmitted
Infections

       

HIV Infection

       

Bone Density