What to bring to a medical appointment for persistent concussion symptoms
Fill in a printable sheet with your symptoms, medicines, past care and questions
You have a new appointment at a concussion clinic, eight weeks after the crash. The front desk asks which medicines you take. The clinician asks when the dizziness began, what your CT showed and whether physical therapy helped. With brain fog, each question can feel like a pop quiz.
A worksheet answers those questions for you. You fill it in at home, at your own pace, and hand a copy across the desk. It also gives you a place to write down the plan before you leave.
This article gives you a printable worksheet in four parts, a packing checklist and tips for using both. If you want help putting symptoms and their effect on daily life into words, a companion article in this section walks through getting ready for a follow up appointment.
What to pack for the visit
Start with your medicines. The Agency for Healthcare Research and Quality (AHRQ), a federal health agency, tells patients to bring every medicine they use to an appointment [1]. That includes prescriptions, store bought products such as aspirin or antacids, vitamins and herbal supplements [1]. An AHRQ guide for primary care practices adds medicines you do not swallow, such as inhalers, drops, creams and shots [7].
Some people carry the actual bottles in a bag. Others bring a printed list. Either works if it is complete and current. If you are not sure which your clinic wants, call and ask.
Packing checklist
Checklist from Safety Behind the Wheel Foundation
- Two copies of your worksheet, one to keep and one to hand over
- All your medicines in a bag, or a complete medicine list
- Photo ID, insurance card and any referral letter
- Reports from scans, such as a CT or MRI, if this clinic has not seen them
- Notes or summaries from other providers, such as physical therapy or an eye exam
- Any symptom questionnaire you filled out recently, with the date
- Your headache diary or symptom log, if you keep one
- Your glasses or hearing aids
- Sunglasses or a brimmed hat, if bright lights bother you
- A notebook and pen, or your phone set up to take notes
- A companion, if someone can come with you
Pack the bag the night before and leave it by the door with your keys. If mornings are hard, a ready bag means one less thing to remember.
Part 1 of the worksheet: your symptoms at a glance
This part gives your clinician a quick snapshot. It works best in short phrases with numbers. The Living Concussion Guidelines, written for adults with concussion, say lasting symptoms should be tracked with a standard questionnaire at follow up visits [2]. If you filled one out before, bring the scores and the date so the team can compare.
The rows below follow the symptom groups the CDC lists after a concussion, such as headaches, dizziness, light and noise sensitivity, tiredness, trouble focusing, mood changes and sleep problems [8]. Skip any row that does not apply, and use the blank rows for anything else.
Worksheet from Safety Behind the Wheel Foundation
Worksheet part 1: my symptoms
| Symptom | When it started | How often and how bad (0 to 10) | What makes it worse or better |
|---|---|---|---|
| Headache | |||
| Dizziness or balance | |||
| Light or noise sensitivity | |||
| Tiredness | |||
| Memory or focus | |||
| Mood, worry or irritability | |||
| Sleep | |||
Print and fill in by hand. Symptom groups based on the CDC [8].
Under the table, write one line with your three biggest problems in order. Then add one line on what has changed since your last visit: better, worse, the same or new.
Imagine a 36 year old line cook who was hit by a turning car while crossing the street. His worksheet shows headaches 4 days a week at 5 out of 10, worse after a shift near the loud dish station. In one glance, his clinician can see what bothers him most and when.
Part 2 of the worksheet: medicines and supplements
The medicine section may matter most for your safety. The Living Concussion Guidelines say an assessment of lasting symptoms should review the prescriptions you take and whether you take them as directed [2]. It should also cover products bought without a prescription, supplements, alcohol, cannabis and other drugs [2]. Being open about all of these helps your clinician sort out what may be adding to your symptoms.
Why an accurate list matters
Errors can start with an incomplete history. A 2008 study followed 180 patients admitted to two Boston teaching hospitals in 2006 [3]. Pharmacists took a careful medicine history and compared it with the hospital’s records and orders. Of the mistakes that could have caused harm, 72% came from errors in the history of what the patient took at home [3]. Most unplanned differences, 60%, were home medicines that were never ordered in the hospital [3]. This was a hospital study, not a concussion clinic, but it shows how much depends on the list the care team receives.
Medication reconciliation is the formal name for comparing lists to catch these gaps when care changes hands [9]. A 2024 summary from AHRQ’s patient safety network found that proof of benefit from reconciliation is mixed [9]. Programs that bring patients into the process look promising, though they have not yet been shown to cut error rates [9].
Worksheet from Safety Behind the Wheel Foundation
Worksheet part 2: my medicines and supplements
| Name and strength | What it is for | How much and when | Who prescribed it, or when I started |
|---|---|---|---|
Include prescriptions, store bought medicines, vitamins, herbal products, inhalers, drops, creams and shots. Based on AHRQ [1, 7, 10].
Other lines to add to your medicine list
AHRQ’s 2011 medicine booklet suggests a list with each medicine’s name, its purpose, how much you take and when, and the date you started [10]. It also says to add a new medicine or a dose change right away and to note any allergies or bad reactions [10]. Below your table, add these lines:
Checklist from Safety Behind the Wheel Foundation
- Allergies, and any medicine that caused a bad reaction
- Medicines I stopped since the crash, when and why
- Side effects I have noticed, with dates
- Prescriptions I am not taking as directed, and the reason
- Days in the past month I took something for headache pain
- Alcohol, cannabis or other substances I use, and how often
In advice written for older adults, the National Institute on Aging suggests writing side effects down so you can describe them accurately [11]. It also suggests filling prescriptions at one pharmacy, so your records stay in one place [11]. AHRQ’s primary care guide asks patients to tell the clinician about any prescription they are not taking as prescribed, and why [7]. Clinicians ask so they can adjust the plan, and an honest answer gives them facts they need.
The headache pain line comes from the Living Concussion Guidelines. They encourage people with headaches after a concussion to keep a diary of both the headaches and the medicines taken for them [12]. They warn that using headache pain medicines often may help keep headaches going [12]. Your clinician can tell you how often is too often for your situation. Check with your prescriber before you stop, start or adjust any medicine, even when you feel better [11].
Part 3 of the worksheet: your care so far
Each new clinician has to piece together what happened since the crash. This part does that work for them. List every visit, test and treatment since the crash, newest first.
Comparison compiled by Safety Behind the Wheel Foundation
Worksheet part 3: care since the crash
| Date | Where or who | What was done | Result or plan |
|---|---|---|---|
| Emergency room or urgent care | |||
| CT or MRI scan | |||
| Primary care | |||
| Physical, vestibular or eye therapy | |||
| Specialist or clinic | |||
Fill in by hand. A scan report or visit summary can back up each row.
Health before the crash
Your history before the crash belongs on the worksheet too. AHRQ advises knowing your medical conditions, along with past illnesses and surgeries, before a visit [1]. For concussion, some history carries extra weight. A 2025 guideline lists migraine, mental health conditions and earlier concussions among the factors that raise the chance of slow recovery [13]. Check any that apply:
Checklist from Safety Behind the Wheel Foundation
- Earlier concussions or head injuries, with dates
- Migraine or frequent headaches before the crash
- Anxiety, depression or another mental health condition
- Sleep problems before the crash
- Other injuries from this crash, such as neck, back or shoulder pain
- Other ongoing health conditions and past surgeries
Scan reports and other records
Bring the reports themselves along with the dates. The 2025 guideline advises against scanning every patient’s brain with MRI or CT, while leaving room for a scan when symptoms are unusual [13]. If you already had a scan, the written report shows a new clinician what was checked and what was found.
You have a federal right under HIPAA, the health privacy law, to look at your health records and receive copies [4]. Providers usually get up to 30 days to answer, but many reply sooner [4]. In most cases you can choose how you get it, such as by email, and you can ask to have it sent straight to someone else, such as another provider [4]. An unpaid bill is not a reason to refuse you [4]. Our article on records to keep after a brain injury covers this process in more depth.
Part 4 of the worksheet: questions and today's plan
The last part has two halves. The top half holds your questions, written before the visit. The bottom half holds the answers and the plan, written during or right after it.
AHRQ suggests writing your questions ahead of time and choosing the three you most want answered [1]. Put those three first. If time runs short, you will still have covered what matters most.
Worksheet from Safety Behind the Wheel Foundation
Worksheet part 4: my questions
| My question | What I learned |
|---|---|
| 1. | |
| 2. | |
| 3. | |
Write your top three questions first. Fill in the right column during or after the visit.
Today’s plan
Before you leave, fill in these lines or ask your companion to:
Checklist from Safety Behind the Wheel Foundation
- Main findings or diagnosis, in plain words
- Changes to my medicines, if any
- Tests or referrals ordered, and who will schedule them
- What to do at home before the next visit
- Date of my next appointment
- Changes that mean I should call sooner, and the number to call
Bringing a companion or recording the visit
A second set of ears helps when memory and focus are part of the problem. A 2011 review pooled studies of routine adult medical visits and found patients brought someone along to 37.6% of them [5]. The companions were most often spouses or adult children [5]. Visits with a companion ran longer, and clinicians shared more medical information when a companion was there [5]. Of the five studies that compared patient outcomes, two found a benefit and three were inconclusive [5].
Federal privacy rules let a provider talk with a family member or friend who helps with your care. That is allowed when you give the OK, or when you raise no objection [14]. Tell the front desk who is with you. Before the visit, agree on a job for your companion. They might take notes, remind you of your top three questions or keep an eye on the clock.
Recording the conversation
Some people ask to record the visit on their phone. A 2014 review of 33 studies looked at patients who received recordings of their visits [6]. On average, 72% listened to them afterward, and in 60% of the studies patients shared them with other people [6]. The review found signs that recordings helped people recall and understand what was said [6]. Most of that research was outside concussion care. Always ask permission before you record, and follow the clinic’s policy.
How to use the worksheet before, during and after the visit
Fill in the worksheet over two or three short sessions in the week before your appointment. Short sessions are easier if focus or screens bring on your symptoms. Ask a family member to help with dates if your memory is patchy, and give them a copy of your medicine list as AHRQ suggests [10].
The day before
Update Part 1 with how this week has gone. Check Part 2 against your pill bottles. Print two copies of the whole sheet.
During the visit
Hand one copy to the clinician or nurse at the start. Keep the other in front of you and work down your questions. If something new comes up, add it to Part 4 so you do not need to remember it.
After the visit
Within a day, finish the plan section while it is fresh. Update your medicine list with any changes. The National Institute on Aging suggests showing your list to every provider you see, including physical therapists and dentists [11]. Then file the worksheet with your other records and start a fresh copy for next time.
When to get emergency care
A worksheet is for planned visits. If any of the CDC danger signs below appear, phone 911 or go straight to a hospital emergency room [8]:
- A headache that grows worse and lingers
- Weakness or numbness, clumsiness, convulsions or seizures
- Repeated vomiting
- Slurred speech or behavior that seems out of character
- Pupils that differ in size
- Not recognizing familiar people or places, or new confusion, agitation or restlessness
- Passing out, extreme sleepiness or being very hard to wake
Questions to ask about your medicines and records
Question checklist from Safety Behind the Wheel Foundation
- Does my medicine list in your system match the one I brought today?
- Could any of my medicines, supplements or other substances be adding to my symptoms?
- How often is it safe for me to use pain relievers for headaches?
- Which of my earlier test results or scan reports do you still need?
- Can your office request records from my other providers?
- Will you send a summary of today’s visit to my other providers?
- May my companion stay for the visit, or join by phone?
- May I record the part of the visit where we review the plan?
- What should I track before my next visit?
Frequently asked questions
Do I need to bring the actual pill bottles, or is a list enough?
AHRQ advises bringing the medicines themselves [1]. Some primary care practices ask for the same, including inhalers, drops and creams [7]. If that is hard, bring a complete list with names, strengths and how you take each one. Ask your clinic which it prefers.
What if my records from the hospital have not arrived?
Bring what you have, and write the dates and places in Part 3 of the worksheet. Under HIPAA, the wait for a records request can be up to 30 days, and it is often shorter [4]. You can also ask the new clinic to request the records for you.
The bottom line
Recommendation from Safety Behind the Wheel Foundation
A two page worksheet can carry your symptoms, medicines, past care and questions into the exam room, so you do not have to hold them in your head. Bring every medicine you take, your scan reports and a companion if you can. Fill in the plan before you leave and update the sheet after each visit. Records rules, clinic policies and health plans differ, so check with your own providers, plan and official sources about what applies to you.
Sources and further reading
- 1Agency for Healthcare Research and Quality. Be more engaged in your healthcare: questions before your appointment. Content last reviewed November 2024. ahrq.gov/…/questions-before-appointment.html
- 2Living Concussion Guidelines (Ottawa Hospital Research Institute). Diagnosis/assessment of prolonged symptoms. Updated April 2023. concussionsontario.org/…/diagnosis-assessment-of-prolonged-symptoms
- 3Pippins JR, Gandhi TK, Hamann C, et al. Classifying and predicting errors of inpatient medication reconciliation. Journal of General Internal Medicine. 2008;23(9):1414-1422. doi.org/10.1007/s11606-008-0687-9
- 4U.S. Department of Health and Human Services. Right to access your health information (HIPAA for individuals). Content last reviewed July 31, 2026. hhs.gov/…/right-to-access/index.html
- 5Wolff JL, Roter DL. Family presence in routine medical visits: a meta-analytical review. Social Science and Medicine. 2011;72(6):823-831. ideas.repec.org/…/v72y2011i6p823-831.html
- 6Tsulukidze M, Durand MA, Barr PJ, Mead T, Elwyn G. Providing recording of clinical consultation to patients: a highly valued but underutilized intervention. A scoping review. Patient Education and Counseling. 2014;95(3):297-304. doi.org/10.1016/j.pec.2014.02.007
- 7Agency for Healthcare Research and Quality. Sample process for medication management strategy. Guide to Patient and Family Engagement in Primary Care. Undated. ahrq.gov/…/medication-mgmt-sample-process.pdf
- 8Centers for Disease Control and Prevention. Symptoms of mild TBI and concussion. Updated September 15, 2025. cdc.gov/…/signs-symptoms/index.html
- 9UC Davis PSNet Editorial Team. Medication reconciliation (patient safety primer). PSNet, Agency for Healthcare Research and Quality. December 15, 2024. psnet.ahrq.gov/primer/medication-reconciliation
- 10Agency for Healthcare Research and Quality. Your medicine: be smart. Be safe. AHRQ Pub. No. 11-0049-A. April 2011. ahrq.gov/…/yourmeds_0.pdf
- 11National Institute on Aging. Taking medicines safely as you age. Content reviewed September 22, 2022. nia.nih.gov/…/taking-medicines-safely-you-age
- 12Living Concussion Guidelines (Ottawa Hospital Research Institute). Post-traumatic headache. Updated August 2022. concussionsontario.org/…/post-traumatic-headache
- 13Silverberg ND, Lee K, Mikolić A, et al. Action Collaborative on Traumatic Brain Injury Care: adapted clinical practice guideline. Annals of Family Medicine. 2025;23(6):552-569. doi.org/10.1370/afm.250352
- 14U.S. Department of Health and Human Services. Family members and friends (HIPAA for individuals). Content last reviewed December 23, 2022. hhs.gov/…/family-members-friends/index.html
This article reflects the safety priorities of concussion recovery and road safety education. It is general education, not medical or legal advice. Medicine questions belong with your own care team, and records rules can differ by provider, so check official sources and ask a qualified professional about your situation. Reviewed October 2026.
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