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Memory Changes Notebook

Write it down. Bring it in.

Record what you're noticing — in yourself or someone you love — and print one clear page for the doctor's appointment.

🔒 Private: saved only in this browser if you choose. Nothing is sent anywhere.

Yourself, or the person you're concerned about.
What have you noticed?Tick all that apply.
The most useful part for the doctor. One per line.
Other changes
Include over-the-counter sleep aids, allergy pills and vitamins. One per line.
Bills, cooking, driving, phone, medicines, hygiene. One per line.
One per line.

Why a notebook

Specific beats general.

Appointments are short, and it's easy to forget details — or to downplay them in front of the person. Dated, concrete examples help doctors see the pattern: what changed, when, and how fast.

Tips

  • Add examples as they happen — a week of notes is better than one memory.
  • If writing about a loved one, you can give it to the doctor privately, or send it ahead.
  • Start from the normal aging or warning sign checklist.
  • Saved only on this device. Print it for the visit.