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
|
|
|
|
|