Free printable
A parent’s one-page health sheet
Every doctor asks the same things. This sheet puts the answers on one page, so you aren’t searching through bottles and letters in the waiting room. It’s for anyone caring for an aging parent.
Free, no sign-up. US Letter for the US and Canada, A4 for most other countries.
What’s on it
- Name and date of birth
- Emergency contact
- Doctors and their phone numbers
- Medicines, vitamins and supplements
- Allergies and reactions
- Health conditions
- Recent test results
- Questions for this visit
How to use it
- 1Print it. It is made for black and white, on one side of one page.
- 2Fill it in by hand, in pencil if things change often.
- 3Bring it to every visit, and hand a copy to the front desk.
- 4Keep a copy where a family member or helper can find it.
The sheet holds private health details, so keep it somewhere safe. What you write stays on paper. Nothing is sent to us. It helps you share facts with a doctor, and it doesn’t replace medical advice. In an emergency, call your local emergency number.
For the results section
Not sure what a number means? The free blood test guide explains each test in plain words.
When paper isn’t enough
We also make Vita: Health Coach, an app that keeps reports in one place and answers follow-up questions in plain words, for you and for the people you look after.
Vita: Health Coach on the App Store