Your life. Your plan.
Asking another doctor
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My main question
What diagnosis, test or treatment do you want another clinician to consider?
What I have been told
Record the explanation, options and what is still unclear.
Relevant changes and information
List symptoms, dates, current medicines and reports. Do not delay urgent help to complete this sheet.
Communication and support
What adjustments do you need? Who do you want involved?
My request and the response
Record who you asked, when, their answer and any reasons for refusal.
Care while waiting
Who remains responsible? What did the clinical team say about treatment, urgency and worsening symptoms?
Next step
Record referral details, follow-up, advocacy or complaint support and the agreed review date.