Use this form for any tests your doctor recommends, such as blood tests, urine tests, or X-rays.
What is the name of the test?
Why do I need this test?
What might happen if the test is delayed or not done?
How accurate is the test? Are there other tests that are more accurate?
How much does the test cost?
Is there a less expensive test that might give the same information?
Questions to ask about the test
What should be done to prepare for the test?
Where will the test be done?
How long does this test take?
How will I feel during the test? Is it painful?
Will I need to arrange for someone to take me home after the test?
What are the risks?
What can the results show?
Will the results change the treatment? Yes ___ No ___ If yes, explain:
What can affect the results (for example, food, exercise, medicine, alcohol, or smoking)?
When will the results be available?
Date I will be notified about my test results:
Date for a follow-up appointment:
After the test, what will be the next step?
Will other tests be needed?
Ask about brochures or other information about the test.
State any concerns you have about the test.
If the benefits of a test don't seem to outweigh the risks, or if the test results will not change the treatment, ask your doctor if you really need this test. Try to agree on the best approach. No test can be done without your permission, and you have the right to refuse a test.
Current as ofJune 25, 2018
Author: Healthwise Staff Medical Review: Adam Husney, MD - Family Medicine Martin J. Gabica, MD - Family Medicine
Medical Review:Adam Husney, MD - Family Medicine & Martin J. Gabica, MD - Family Medicine