Walk Into Your Next Appointment Confident and Ready to be Heard
Doctor Visit Prep Sheet: The Self-Advocacy Checklist
Use this comprehensive planner to prepare for your upcoming visit. Bring this sheet to your appointment to help track your symptoms, ask important questions, and stay clear on the next steps for your care routine.
How to Use This Checklist
Many patients are asked the same questions at every appointment: “What medications are you taking?” “What treatments have you already tried?” “When did symptoms begin?” Having these details written down can save energy, reduce stress, and help your provider see the bigger picture.
- Type your details: Write in your physician’s name, clinical appointment date, and your current symptom experiences in the active fields below.
- Erase or expand lines: Use the live toolkit action bar below the matrix to add your own custom patient questions or completely reset the template back to baseline.
- Print your template: Click the purple “Print My Checklist” action button. This generates a clean clinical worksheet with physical handwriting lines.
- Save for later: Your selections automatically lock straight to your system browser. Close this page anytime and return whenever you wish without losing your progress.
Your Privacy is Guaranteed
100% Local & Anonymous: Your privacy is highly sacred. All notes, symptom tracking descriptions, and provider information you input on this page are stored entirely in your device’s browser local memory (LocalStorage).
LSSN never collects, transmits, or views your personal health tracking data. Your files are completely safe, private, and yours alone.
 | Self-Advocacy ChecklistLichenS Support Network (LSSN) — Patient Advocacy Checklist |
1. Medications You’ve Taken Recently
Your provider may ask about medications, treatments, supplements, illnesses, or major health changes that occurred before symptoms appeared. Use this section to create a simple timeline you can reference during appointments.
2. What You’re Experiencing Right Now
Lichen planus presents differently across different areas of the body. Writing down your daily experiences helps your healthcare team understand how your symptoms impact your life.
| Topic | Questions to Ask Your Doctor | Doctor’s Answers & Plan |
|---|---|---|
| Scope | “How do you typically approach a condition like lichen planus that can show up in multiple different areas of the body?” Why Ask This: Lichen planus can affect the skin, mouth, and genitals at the same time. This ensures your doctor evaluates your whole body rather than looking at just one localized spot. | |
| Behavior | “What are the different ways this condition might behave over time, and how will we track changes?” Why Ask This: Skin spots may resolve naturally within a few years, while mucosal variations can be long-standing and require dedicated care. This helps establish an active tracking plan tailored to your specific situation. | |
| Treatments | “If my symptoms do not respond to initial topical care, what is your process for exploring other treatment options?” Why Ask This: Mucosal subtypes frequently require moving beyond standard creams to specialized systemics or targeted immune therapies. Looking forward to your doctor’s next steps helps avoid prolonged, ineffective treatments. | |
| Triggers | “Are there specific everyday triggers, oral care products, or physical stressors you recommend I monitor right now?” Why Ask This: Simple localized friction, intense mint or cinnamon flavorings, or repeated physical friction can worsen inflammation or cause new lesions to flare up. Identifying these early gives you active control over your recovery environment. | |
| Follow-Up | “When should I schedule my next follow-up, and what changes would make you want to see me sooner?” Why Ask This: Knowing what symptoms require earlier attention can help you feel more confident and avoid unnecessary delays in care. |
| LichenS Support Network (LSSN) — Patient Advocacy Nonprofit This Self-Advocacy Visit Checklist was developed independently by the LichenS Support Network (formerly Lichen Sclerosus Support Network) to support patient self-advocacy and clarify clinical decisions. Explore more tracking resources at aboutlichenplanus.com. | Supported by:  |
Reset Your Custom Checklist?
This action will completely erase all of your typed symptoms, answers, medication timelines, and custom questions. This cannot be undone.
