GP one-page handover (print-only)

Fill this in to read out or hand over at your appointment. Nothing is saved or uploaded — if you refresh or leave, it clears.

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One-page handover

Name (optional) Date Day type

Main reason (one line)

Top impacts (tick up to 3)

Sleep Leaving the house Work/study Cooking/eating Money decisions Washing Dressing Social Panic/meltdowns Memory/focus

Reasonable adjustments

quiet waiting / wait outside dim lights if possible one thing at a time written next steps supporter may speak if I freeze

Safety flags (if relevant)

falls / unsteady / burns risk thoughts of self-harm (safe today) can’t manage meds safely need help to leave house

Examples (two short lines)

Current meds (optional)

What I’ve already tried

Today I’m asking for one thing

For the GP to complete (optional)

Hand this over and ask for it back, or write it down together.

Plan / next steps

Follow-up / review date Clinician initials (optional)

If you’re in crisis

Call 999 if you’re in danger. Call Samaritans 116 123 or text SHOUT to 85258.

More crisis options

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Awareverse · Sensory products & resources for neurodivergent individuals
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