Free printable
A symptom summary you can hand over.
Updated: 9 October 2026
On a bad day, speaking is the hard part. This sheet says it for you: why you're here, what has changed, how often it happens, and what it stops you doing.
It's written in your words, about your own experience. Filling it in beforehand means the appointment starts from reading rather than remembering.
No sign-up. Print it, or download it as a PDF. To print, press Ctrl and P, or Command and P on a Mac, and only the sheet below goes on the paper. Everything else, including this paragraph, is left off it.
How to use it
- Write it at home, over a few days if that's easier
- Where you can, use counts: how many difficult days, how often, how long
- Say what the symptom stops you doing, because that carries more than a number out of ten
- Hand it over at the start, and keep a copy for yourself
Symptom summary
Date For which appointment
I'm here because
The main problem I need help on
When it started, or when it changed
How often it happens, and how long it lasts
What it stops me doing
What I've tried, and what happened
What I would like from today
This is my own account of my symptoms, written by me. It is not a medical record.
taluvu.co.uk · Free printable
Printing these sheets for other people
You're welcome to print or photocopy these sheets and hand them out on paper, as many copies as you need, and you don't have to ask us first. That includes support groups, charity volunteers, ward and clinic staff, libraries, schools, and anyone helping someone else keep a record. There's nothing to pay and nothing to sign.
Questions people ask
What should a symptom summary include?
Why you're there, what has changed and when, how often it happens and for how long, what it stops you doing, what you have already tried, and what you want from the appointment.
Will a doctor read something I hand them?
Usually yes, especially one page. It's quicker to read than to ask for, and it means the detail exists in the notes even if time runs out.
Can I use this for a hospital appointment too?
Yes. The sheet doesn't assume who you're seeing, so it works for a GP, a consultant, a nurse or a therapist.
Is there a PDF I can send ahead instead of printing it?
Yes. Press Download as PDF near the top of this page for the blank A4 sheet as a file. Fill it in and attach it to an email to the practice or upload it to an online form. Filling the paper copy in by hand and photographing it works just as well, so use whichever is less effort on the day.
More sheets, and where to go next
If you would rather not write it by hand
taluvu is a chronic illness tracker for iPhone and for your web browser that keeps the same kind of record in about a minute a day, and turns it into a summary you can take to an appointment. The sheet above works perfectly well on its own.
taluvu Chronic Illness Tracker
TALUVU LTD · Health and Fitness · iPhone
Free to download, with a taluvu Pro subscription inside
Nothing on this page is medical advice. If you are worried about your health, contact your GP practice or NHS 111. In an emergency ring 999, and if you are struggling to keep yourself safe, Samaritans are on 116 123. How we write these pages.