2
My appointment date
Doctor
Where is my appointment?
My appointment time
My support person is
My Epilepsy Review Appointment Easy English May 2013

Answer the questions
1 What is something good that has happened to you in the last 4 weeks?
2 What does your epilepsy stop you doing?
3 Tell me about your seizures.
For example, how often do you have a seizure, how long does the seizure last, are there any patterns?
My Epilepsy Review Appointment Easy English May 2013 3

4
4 Have you hurt yourself since your last review appointment?
For example, from seizures, from something else.
5 What has happened with
● going to sleep?
● the times you wake up?
For example, is it hard to go to sleep, do you wake up in the middle of the night, do you wake up early.
6 Has your mood been different?
For example, happy, sad, not interested, cross.
My Epilepsy Review Appointment Easy English May 2013

7 Your medication for epilepsy
What side effects do you have?
Is it hard to take your medication?
Do you need more scripts?
What other medication do you take now?
My Epilepsy Review Appointment Easy English May 2013 5

1 This form.
2 Write a 2 page summary of your seizure review chart.
3 Epilepsy Management Plan and
Treatment or Medication Sheet.
6 My Epilepsy Review Appointment Easy English May 2013

4 Test results and doctors reports from the last 6 months.
5 Webster pack.
A webster pack is the pack where you keep your medication.
My Epilepsy Review Appointment Easy English May 2013 7

You can write more notes here.
Scope’s Communication Resource Centre wrote the Easy English.
May 2013. www.scopevic.org.au.
To see the original form, contact the Epilepsy Foundation of Victoria.
www.epinet.org.au
Mayer-Johnson LLC says we can use the Picture Communication
Symbols © 1981 – 2013.
Change pictures © 2011. www.changepeople.co.uk.
8 My Epilepsy Review Appointment Easy English May 2013