Doctor’s appointment worksheet for heart failure
This sheet can help guide your conversation with your doctor. Fill this out with your provider, or bring it with you as a reminder of important questions to ask
What is my blood pressure goal? (Systolic/Diastolic)
mmHg
What is my dry weight?
Pounds
When should I notify the clinic of weight gain?
Pounds
Any specific instructions for weight gain or high blood pressure (like extra dose of medication)?
Test to complete
Do I need any tests or labs done to monitor my heart disease?
Medications
Do I need to make any changes to my medications? (Make sure to track these on your Heart Failure Medicine Tracker)
Lifestyle goals
Based on my eating, sleeping, exercise, and other habits, what are the right goals for me?
Exercise Goal
Nutrition Goal
Sleep Goal
Other Goals (Alcohol, coffee, stress, smoking, etc.)
Was this article helpful?
Sign up to unlock your health, your way at no cost to you.
This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
You may not be eligible for all services. Log in to view the benefits included in your plan.