Help/Questions: Appointment Request Form Questionnaire

Posted by ashleykraw @ashleykraw, Nov 6, 2023

My rheumatologist recently sent a referral to Rochester under internal medicine after I had an onset of worsening, multiple body system symptoms and recent hospitalizations (now on home health). Many hospital specialists told me I needed a team of specialists and recommended Mayo. A representative from Mayo called me and told me they had my referral and I would receive an email with an appointment request form questionnaire. I haven't yet received it but they said I would have 24-48 hours to fill it out and there is no save button; this makes me a little nervous to get it right.

The representative said it would consist of 4 questions: What is my concern, who have I seen, what meds/treatments have I received, and what am I hoping to get out of this process? They explained I could put concerns like weakness in my right thigh, tremors in my left hand, and then answer the remaining questions on those concerns. I have many symptoms and I haven't seen the form/email yet. I've been told my acceptance will be based on this. Can anyone who's completed this give me a better idea of how best to fill this out?

My questions:
1. Do I list every single symptom/concern I have all at one time for the first question? "What is my concern?"
2. Is it best to list broad concerns like multiple area muscle weakness, tremors, etc.? Or, is it best to list very specific concerns like muscle weakness in thighs, face and hand tremors, etc.?
3. Should I also list diagnoses with these concerns like ataxia, dysphagia, gastroparesis, uveitis, etc., or is it best to leave off the diagnosis and just stick with symptoms?
4. For the question, "Who have I seen?" Should I list any upcoming appointments I have scheduled with new providers/specialists?
5. I'd greatly appreciate any other helpful information you can give. TIA

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Hi @ashleykraw, you're asking really good questions to be prepared for filling out the form. I can understand your apprehension about getting it right. It sounds daunting, but our digital specialists have worked hard on making the form simple and easy to use.

Here are some tips to help you get things ready for filling out the form.
1. What is my concern?
The question will have a character or word limit. So list your main concern first. This concern may be a symptom or a diagnosis. Focus on the thing or things that are most affecting your quality of life, the main medical concern. It doesn't need to be a complete list of all symptoms.
2. Broad descriptions vs specific: this may be limited by the character account. Focus on what is most important to you.
3. See answer number 1.
4. Start with recent providers you have seen, then add upcoming appointments.
5. You stated "Many hospital specialists told me I needed a team of specialists and recommended Mayo." You may consider adding this to the last question.

Keep in mind that they also have the medical information submitted by your rheumatologist. Your information helps give a fuller picture about you.


ashleykraw @ashleykraw

I have never had fill out form (life long patent at Mayo). But will give you some advice on entering info into form.

Create a word / text document on your computer first and type your answers in that. Then when get form, copy / paste answers into form. Seeing you said there was no SAVE button, this will allow you to think about answers and not have to worry about typing in and then accidently losing them.

After paste, make sure you have not exceeded char limit and part of answer is truncated. If it is over char limit, you will need to go back and edit answer so shorter.


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