My Appointment Prep Sheet
A one-page worksheet to fill out before you see your doctor. Covers what you're using, how often, withdrawal symptoms, your current situation, and the exact sentences to say in the room.
Appointment Prep Sheet (PDF)
1 page · Print or fill on your phone · Free
No email required. No account. Print it, fill it out, bring it with you.
What's on the sheet
Eight common substances with checkboxes. Check everything that applies. Your doctor needs an accurate picture, not a filtered one.
Twelve common symptoms to check off. Seizure history is included as a separate item because it's the one that most directly affects how your doctor assesses medical risk.
Two boxes: one for readers whose lives are still functioning, one for those who need urgent help. Each leads to a different script at the bottom of the sheet.
Two ready-to-read sentences for your opening statement. If you freeze in a medical setting, you can hand the sheet to the doctor and point. That's a legitimate strategy.
For the full guide on how to structure the appointment, what to ask for by substance, and how to preempt a residential referral, see the companion article: How to Talk to Your Doctor About Substance Use (Without Getting Sent to Rehab).