Recollection of your condition’s onset while in the treatment room- is simply not enough. Fill this template out before your office visit and provide your health professional a quick snapshot of the condition(s), onset, and current treatment regimen to save you and your service provider a significant amount of time. By completing this form, you will pave the way for a more information-driven appointment. An in-depth tutorial found in Section 3 Article 6 Titled: “Chronic Conditions and the American Payout”. This worksheet is designed for you to “pick up where you left off” meaning that if you have neglected condition and you have found the right provider to get you back to health.


According to the CDC, the leading causes of death and disability as well as the leading drivers to the nation’s $3.5 Trillion annual healthcare costs- are chronic conditions. Six out of ten adults have a chronic condition and 4 out of 10 have 2 chronic conditions or more. This worksheet frees up the valuable treatment room time recalling your condition(s) and allows for a quick assessment and advance in a more in-depth evaluation. This is a mid-level worksheet is designed for chronic conditions that have been previously diagnosed.


  • Fill out the form to the best of your ability.

  • Copy the information if you need to update the worksheet and share it will every professional.

  • Don’t throw this Chronic Condition From away after use, instead, put it in your Specialty pocket behind label “SPC” in your health manager.

P.S. On the backside of this worksheet, we’ve included a “mini plan” for you and your professional to start collaborating immediately.

Click Here to Download ConDITION MANAGEMENT FORM