Comparison and Selected Examples of Information Provided on Pre-Visit Forms
| Questions | Answers (Examples) |
|---|---|
| Control group | |
| Which symptoms or problems are bothering you the most lately? | Leg, pain with walking Back pain, back spasms Fibromyalgia; arthritis Dizziness, neuropathy Diabetes, foot pain Eyes floaters, stomach-diarrhea ADHD medication Bone infection Toenail fungus |
| Intervention Group | |
| 1. What things are you unable to do as a result of your health problems? | Flowering/gardening, taking shower by self Get comfortable, get dressed, take shower, cook, walk, roll over Most things, sadly; anything with exertion |
| 2. What other things would you like to be able to do that you can’t do now? | Get dressed, stand and walk to cook Have a better memory for everyday things, school life, etc. Cooking on my own, doing things my way when I want to |
| 3. What activities make life worthwhile for you (that you wouldn’t want to have to give up)? | Doing my own thing, go to bedroom from bathroom Taking care of my son, bathing self, being able to walk outside Spending time with loved ones |