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Claire Elise Wellness

Provider Question Map

A printable map for goals, facts, unknowns, benefits, risks, alternatives, costs, follow-up, and the questions that can change a professional decision.

Available resource

Consultation Literacy

Turn uncertainty into a better appointment conversation.

Bring a clearer question into the room without turning a worksheet into a self-diagnosis.

Print this question map

My purpose for the visit

The decision or concern I want to address:

The outcome I am hoping for:

What I do not want overlooked:

Facts, observations, and unknowns

Current facts I can document:

Changes I observed and when:

Information I do not have:

Claims or service descriptions I want translated:

Questions that change the decision

  1. What reasonable explanations or categories are you considering?
  2. What information would narrow those possibilities?
  3. What are the benefits, limitations, and material risks of the proposed next step?
  4. What alternatives include doing less, waiting, or using a different professional?
  5. What would make this option inappropriate?
  6. What cost, maintenance, follow-up, or repeat treatment should I expect?
  7. What remains uncertain or not established?
  8. What symptoms or changes should alter the plan or prompt urgent care?
  9. How will we know whether the next step helped?
  10. When should the plan be reviewed again?

My consultation receipt

What was recommended:

Why it was recommended:

Alternatives discussed:

Material risks or limitations discussed:

What I need to verify before acting:

Next review date or trigger: