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My Care Tracker

Date of Activity Being Tracked

The date defaults to current date, but you can select a time within the previous 365 days for your tracker entry, if needed.

MM slash DD slash YYYY

Time

Hours

:

Minutes

AM/PM

Coach's Tips on how to use these Trackers

Use this tracker every time you seek care.

My Care Tracker

Who did you meet with?

Full name and title

What type of care did you receive?

Wellness Checkup

Specialty Health Visit

New Health Concern

Mental Health Counseling

Pre-Op

Procedure

Post-Op

Other

What questions do you have for your healthcare provider for this visit?

Coach’s Tip: You can text OR use your phone voice option to easily capture your questions here.

Do you have to schedule another appointment?

Yes

No

Not Sure

Additional Notes on visit

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My Care Tracker

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