Help/Questions: Appointment Request Form Questionnaire
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?
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