Questionnaire · Anna Keller, 47
Questionnaire

Check-up questionnaire, sent 12 September

Anna Keller, 47 · 12 September 2026 · Shared with the patient, 12 September 2026, opened

As it reached her phone

What would you like to talk about?
Routine checkA new problemSomething from the last visitMedication
Your home blood pressure last weekNew

Mean 136/86, highest 148/92, mornings and evenings

The mean of the week, and the highest single reading. Both are in your plan of 16 March.

Weight84 kg
WaistOptional94 cm

Measured at the navel, standing, after breathing out. Together with the weight this is what the risk calculation uses.

Has anything about your medication changed since May?
Nothing has changedA dose changedSomething was stoppedSomething new was added
You stopped a cholesterol tablet in 2024. What happened then?New

Muscle aches in both thighs after six weeks. Gone two weeks after stopping.

Asked because the chart records simvastatin stopped in March 2024 without a reason.

How many days a week do you move for at least twenty minutes?
012345678910
Anything new since the last visit?OptionalNew

Headaches in the afternoon, two or three times a week

Answers are stored in the chart under your name and marked as entered by the patient. Nothing is shared with anyone else.

Sources

Practice template, 23 questionsChart of Anna Keller, 14 documentsPlan 16.03.2026

Written from the practice's own check-up template and the chart: questions the record already answers were dropped, questions the record raises were added. Sent as one link, no app to install, answers back in the chart.