Table 2

Comparison and Selected Examples of Information Provided on Pre-Visit Forms

QuestionsAnswers (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