My notes for the doctor
A printable from Depression and Anxiety Signs. Fill it in by hand. Nothing you write is collected by this website.
My notes for the doctor
- What I have been feeling, in a few words
- When it started, and if something happened around then
- How many days a week I feel this way
- Sleep: hours a night, and if I wake up early
- Eating: more or less than before
- Body signs: headaches, stomach, heart racing, chest tightness
- What it is keeping me from doing: work, family, church, school
- Alcohol, drugs or medicines I am taking, including from my home country
- Questions: "Could this be depression or anxiety?" "What are my choices for care?" "What does it cost?" "What do you keep private?"
- The language I want to use
If you have thoughts of suicide, call or text 988. If a life is in danger right now, call 911. You do not have to write your immigration status on this sheet.
From Depression and Anxiety Signs. Facts checked October 21, 2026. Free information, not legal or medical advice.