Preconception Appointment Checklist
Print the blank sheet to fill in
The book's explanations for this sheet (PDF)
How to use it
- Print it, or keep it open on your phone. The version you will still have with you in the room is the right one.
- Fill it in at your own pace. One sitting works, and so does adding to it whenever something occurs to you.
- For part one, gather what you already have: medicines, vitamins, supplements and herbal products, notes about health conditions and past pregnancies, family history, any vaccination record. Photographs of labels count. Where you do not know something, write that down instead of guessing.
- In part two, keep the questions that fit your situation and add your own. You do not need to complete every box before asking for care.
- Write part three from anything prescribed, ongoing or long term. You are not deciding anything about it here, you are making sure it gets raised.
- Take it with you and hand it over if that is easier than saying it. A partner or someone you trust can come along or write for you, if that is safe; you can also ask to see the professional on your own.
- Before you leave, write down what you agreed, who does the next thing and by when.
Do not stop, start or change a prescribed medicine because of anything written on this sheet. Part three is there so a treatment gets raised with a professional, not adjusted at home. If there is immediate danger, severe illness or violence, contact the local emergency service or a confidential support service where you are now, rather than preparing an appointment.
Read the sheet on screen
Make room for the questions that matter to you
Use these notes to prepare a conversation with a healthcare professional before pregnancy. Keep them on paper or somewhere private on your phone. You can ask a partner or trusted person to help, if that is safe: if someone could read these notes or control your care, keep them to yourself and ask to speak to the professional alone.
You don't need to complete every box before asking for care.
1. What I can prepare
Start with your main concern or goal. One line is enough, and it is what you want the appointment to cover.
What to bring, if I have it
Tick what you already have. A gap here is not a reason to put off the appointment.
- A list of medicines, vitamins, supplements, and herbal products I use
- Notes about health conditions, past pregnancies, and relevant family history
- Any vaccination records I already have
- Support I may need, such as an interpreter or time to talk privately
Keep personal health notes somewhere private. You can discuss sensitive details directly with the clinician rather than writing them on a shared sheet.
2. What I want to ask
These questions are examples. Choose the ones that are useful to you; you do not need to ask them all.
- Do any of my medicines or health conditions need a plan before pregnancy?
- What should I know about folic acid, other supplements, and vaccinations?
- Are there tests or referrals to consider because of my own or family history?
- Where can I get help with mental health, alcohol, smoking, or other substance use?
- Is there anything about work, home, fertility, or my partner's health to discuss?
My questions, in my own words
Write them before you go. Handing this over is easier than remembering them in the room.
My first question
Another question
3. What needs professional advice before I change it
List a medicine, treatment, or health plan you want reviewed. This is a list to discuss, not a list of things to stop. Don't change prescribed treatment on the strength of this sheet.
Before I leave
Fill these in while you are still in the room, not afterwards.
What we agreed
Next action, person responsible, and date
Who to contact with another question
If you’re already pregnant, ask the midwife, doctor, or maternity service caring for you to review these notes in light of the pregnancy. You can still bring your medicine list and questions.
If you are already pregnant
You do not have to start again. Contact the midwife, doctor or maternity service looking after the pregnancy and ask them to review these notes. Your medicine list and your questions are still the right things to bring.
What this will not do
- It carries no recommendation. No dose, no supplement, no test, no timing, no threshold. Naming a topic worth raising is a different job from answering it.
- It cannot tell you whether something is safe before or during a pregnancy. That depends on your own history, and the answer belongs to a clinician who has that history in front of them.
- It does not replace an appointment and it is not a screening tool. A line left blank is not a result.
- What care exists near you, who provides it and what it costs depend on where you live, and this page knows nothing about that.
Privacy and sources
This page has no form: nothing on it is typed, saved or sent. Printing goes through your own browser.
Sources of this sheet
- Preconception care to reduce maternal and childhood mortality and morbidity
World Health Organization. Frames what belongs in a pre-pregnancy conversation. International framing; national schedules and products replace it locally.
- Prepregnancy Counseling (Committee Opinion)
ACOG. Supports the list of topics worth raising with a clinician. United States scope.
- Antenatal and postnatal mental health: recommendations
NICE. Supports raising mental health before pregnancy, not treating it. Clinical guidance written for health services. What is offered where you live depends on your own health system.