Print this form and fill in the information for blood, urine, X-ray, or any other test your doctor recommends. You may need to make copies if more than one test is recommended.
General questions
What is the name of the test? |
Why do I need this test? |
What might happen if the test is delayed or not done? |
How accurate is the test? Are there other tests that are more accurate? |
How much does the test cost? |
Is there a less expensive test that might give the same information? |
Questions to ask about the test
What should be done to prepare for the test?
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Where will the test be done? |
How long does this test take? |
How will I feel during the test? Is it painful? |
Will I need to arrange for someone to take me home after the test? |
What are the risks?
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What will the results show? |
Will the results change the treatment? No ___ Yes ___ If yes, explain:
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What can affect the results (for example, food, exercise, medicine, alcohol, or smoking)?
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When will the results be available? |
Date I will receive a phone call from my doctor: |
Date for a follow-up appointment: |
After the test, what will be the next step? Will other tests be needed? |
Reminder
Credits
| By | Healthwise Staff |
| Primary Medical Reviewer | Adam Husney, MD - Family Medicine |
| Specialist Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
| Last Revised | December 9, 2011 |