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.
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