AKAnna Keller, 47 · Hypertension, prediabetes, LDL 162 mg/dl · 14 documents, read 16 September 2026
Show me the sheet as she gets it.
Answered on 16 September 2026
This is her side of the same sheet, question by question, in the wording that goes out. No medical shorthand, no scale without its ends written out, and every question answerable on a phone in a waiting room.
Two things stand in it that are not questions. The first is why it is being asked, in one line, because a form that explains itself is answered more often. The second is the sentence that says what the sheet is not: it gives no advice and answers nothing, and anything urgent is a phone call to the practice.
She can stop halfway and come back; what is answered is kept. Nothing reaches the chart until she sends it.
QuestionnaireDraft, for your signature
Check-up questionnaire, as she receives it
- Eight questions in her wording, answerable on a phone
- Why it is asked, in one line, at the top
- What the sheet is not, and which number to call
It reaches her under your name, once you have read it
What would you like to ask next?
1What did she answer?2Ask her for a week of home readings before the visit3Show me her home readings before the visitThis is a sample workspace. Click one of the questions. To ask your own questions, request access.
Anna Keller, 47Mosaic