A prepared first appointment begins with the person’s priorities and the receiving provider’s instructions. Use this original worksheet to organize both. Print it, complete it privately and ask the provider how any requested records should be transmitted.
Tool 1: Before the appointment
- Person’s main concern and question:
- Provider or public service contacted:
- Name and role of the person scheduled to see you:
- Appointment purpose, date and time:
- Confirmed address or virtual access instructions:
- Travel, arrival and check-in plan:
- Requested documents and secure submission process:
- Fee, coverage or eligibility question still open:
- Family or supporter participation the person wants:
- Permission question to clarify with the provider:
- Contact for rescheduling or access problems:
Bring focused questions
Ask about experience with the concern, the approach used and what the provider needs before making a recommendation. NIMH suggests questions about expected treatment duration, insurance and cost. Do not expect an appointment worksheet to resolve those matters before the provider has answered. NIMH provider questions.
If a county access route is relevant, the official Los Angeles County resource page identifies the Help Line and the services it routes. Ask that service about the practical next step for your situation. County access resource.
Tool 2: Leave with an actionable next step
- Recommendation made by the provider:
- Question requiring further clinical clarification:
- Next receiving contact and appointment status:
- Practical task, agreed task owner and due date:
- Date to review the unresolved items:
Keep the provider’s clinical instructions with their source. Mark a proposed appointment as proposed until confirmed. Share the completed sheet only with the people appropriately involved, using the provider’s permission and records process. The worksheet organizes the conversation; it does not replace a clinical evaluation.