https://www.texasliver.com/printable-form/
Printable Form
Liver Specialists of Texas
6624 Fannin, Suite 1990
Houston, Texas 77030
713-794-0700
www.texasliver.com
Joseph S. Galati, M.D.
Patients Name: _______________________
Date of Visit: ________________________
Physician: ___________________________
Specialty: ____________________________
Questions To Ask Physician/Staff
1. __________________________________________________________________
2. __________________________________________________________________
3. __________________________________________________________________
4. __________________________________________________________________
5. __________________________________________________________________
Current Medications
__________________________________________________________________
Changes in Medication Made Today (Discontinued or Added)
__________________________________________________________________
New Tests Or Procedures To Be Scheduled/Consultation With New Physicians
__________________________________________________________________
Follow-up Appointment: _________________