Free template · PDF · US Letter
Free Printable Dermatologist Visit Summary Sheet
This is a free, one-page printable summary sheet to bring to a dermatology appointment. Fill in the last 4–8 weeks: flare frequency and severity, current treatments and how they're working, new triggers you've noticed, and the top three questions you want to ask. Not medical advice — a communication aid for your visit.
Dermatologist Visit Summary Sheetsoftgrove.github.io
| Section | What to fill in | Space |
|---|---|---|
How to use this sheet
- Print the PDF a day or two before your appointment.
- Fill in the recent-flares summary: how often, how severe (0–10), where on the body.
- List current treatments (topicals, orals, phototherapy) and whether they've helped, done nothing, or made things worse.
- Note any new triggers you've observed and any photos or videos you'd like the doctor to see on your phone.
- Write your top three questions at the bottom — you're much more likely to actually ask them if they're on paper.
Questions
Is this sheet really free?
Yes. The PDF is free to download and print — no sign-up, no email.
Why bring a summary sheet at all?
Appointments are short. A one-page summary lets your dermatologist see the last few weeks at a glance instead of relying on your recall in the exam room.
What if I don't have a treatment list yet?
Fill in what you're currently using — over-the-counter creams count. The point is a shared starting point, not a complete medical record.
Is there an app version?
Yes — Skinote for iPhone keeps a running eczema log with photos and can export a dated PDF summary for your appointment. Core is free, no account needed, data stays on your device.
Want the log to analyze itself?
Skinote for iPhone tracks the same things in seconds and shows you the patterns — free core, no account, and everything stays on your device.