ÉCRIVEZ VOS QUESTIONS ET VOS INQUIÉTUDES POUR VOTRE MÉDECIN.

UTILISEZ CET ESPACE POUR PRENDRE DES NOTES À LAQUELLE VOUS POURREZ VOUS RÉFÉRER PLUS TARD.

 

Rendez-vous avec: _________________________________________________________________ Date: ____________

Raison de la visite: __________________________________________________________________________________

 

Liste des questions/des inquiétudes:

1. _________________________________________________________________________________________________________________________

    _________________________________________________________________________________________________________________________

Réponse: ___________________________________________________________________________________________________________________

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2. ________________________________________________________________________________________________________________________

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Réponse: __________________________________________________________________________________________________________________

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3. ________________________________________________________________________________________________________________________

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Réponse: __________________________________________________________________________________________________________________

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4. _______________________________________________________________________________________________________________________

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Réponse: _________________________________________________________________________________________________________________

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5. _______________________________________________________________________________________________________________________

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Réponse: __________________________________________________________________________________________________________________

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American Pain Foundation                                                                                             La fondation américaine de la douleur

A United Voice of Hope and Power over Pain                                                                Une voix unie d'espoir et de pouvoir sur la douleur

Pour plus d'information ou pour être impliqué, appelé sans frais à 1-800-615-PAIN (7246) ou visitez www.painfoundation.org.






Traduit par Louise Rochette Louise
Email: LouiseRochette@gmail.com