My next appointment and backup
For adults arranging follow-up after treatment. Fill this in with a staff member if helpful. Use one sheet for each appointment you want to keep track of.
AHRQ recommends arranging follow-up with the patient and checking how they will get there. Mark an appointment unconfirmed until the service agrees to the details. [1]
Fictional example: Thursday 10 a.m. is confirmed. The ride home is not. Lee will check transport and call me Wednesday by noon.
Keep completed notes private. You can leave a box blank or ask someone to help. Save a copy before leaving this page. Notes are not sent to AddictionHelp or saved automatically. Closing or reloading this page can lose them. The PDF is one page. Printing longer web notes may use more pages.
Write brief notes. Ask staff to help with anything still missing.
Service, date/time, address or video details, phone and who confirmed it.
Travel both ways or phone/video access, cost questions and other arrangements.
Who to contact, number/hours, and backup if there is no answer.
What is missing, who will check, when I will hear back and whom I can call.
This appointment organizer goes with your care team’s discharge, medicine and urgent-help instructions. It does not replace them. Keep those instructions with this sheet. If you need help sooner, use the team’s urgent-help plan instead of waiting for this visit.
Need more room or context? Use My Discharge and Follow-Up Plan.