Patient-Doctor Telephone Consultation Record Form

Patient-Doctor Telephone Consultation Record Form is used by physicians, medical practitioners, and doctors when any patient is unable to pay a physical visit to his/her physician.

The form helps in keeping a record of phone consultation between doctor and the patient. This consultation form is used to record the patient message and is helpful when these patients are called back.

There are doctors who provide phone consultation and there are doctors who help their patients who cannot visit due to long distance or other circumstances. The doctor calls back the patients who had called earlier and the medical phone consultation form filled earlier by the assistant or nurse assisting the doctor plays a vital role while discussing with the patient about the problems. This form helps the doctor to address the specific concerns and health issues in detail and with precision.


Medical phone consultation form includes the information about the caller, the nature of call urgent or routine, the frequency of call, the time and date, details of history, results of tests if were recommended earlier, details of medicines used. Generally, medical conditions are not diagnosed over the phone however many doctors suggest further diagnostic procedures and medical testing that are helpful in diagnosing your problems.

In case the patient is under treatment of a doctor in his area and wants a medical consultation from some other specialist or physician, this form is of great help. In this case, the approached doctor can record the patient’s data in this form and can guide and recommend solution in details.

 Preview and download options

Sample Form-1   (2 per page)

Patient-Doctor Telephone Consultation Record Form


Sample Form-2   (2 per page)

Patient-Doctor Telephone Consultation Record Form


Simi Karton

Simi Karton is a regular contributor to National Science Quarterly and an enthusiastic Lakers fan. She recently collaborated on a manuscript with friends and colleagues. Dr. Simi Karton, entitled Parkinsons and the Genetic Response to Eastern Medicine, in which she and Dr. Inshal presented research compiled during a summer spent in United States. She currently resides in Los Angeles with her husband. This website is a voluntary work of Dr. Karton to provide people with useful health related information stuff at an easy approach. The information has been collected from different sources at one place.

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