Take Back Trust: Provider Visit Planner

Take Back Trust: Provider Visit Planner

This tool is to help you make the most of your upcoming appointments with your healthcare provider. Select any applicable questions to create a personalized list. After completion a personalized PDF will be created that can be emailed to you and downloaded. Feel free to screenshot or print it and take it to your appointment.
Reproductive Health & Abortion Care

How do recent changes in reproductive laws impact the care I can receive, especially regarding abortion?If I need an abortion, what are my options in or out of state?Do you provide abortion care? If not, can you help with referrals or guidance?How do you ensure patient privacy, particularly if I need care related to abortion or sensitive reproductive health matters?What are your thoughts on state-level abortion bans and how they might affect my health care options?
Birth Control & Contraception

What birth control methods would you recommend based on my health history and lifestyle?Are there new or more effective birth control options that I should consider? What about a longer acting birth control method?Can I switch my birth control method, and how do I go about transitioning?What should I do if I miss a dose or need emergency contraception?How can I ensure continued access to birth control, especially in light of changing legal landscapes?
Family Planning & Fertility

If I’m thinking about having kids in the future, what are the best steps to take now to preserve fertility?If I’m currently on a birth control, what’s the best way to transition off of it to get ready to be pregnant and is there any other testing I should consider now?Should I get fertility testing done, even if I’m not planning on having children right away or not sure if I want to have children?What’s involved in genetic testing for family planning, and should I consider it?Can you help me understand how my age, current health, and past medical history could affect my ability to get pregnant?What are my options for fertility preservation if I’m considering postponing pregnancy?If I have frozen embryos or eggs, what should I know about storing or using them, especially if laws change?I currently take medication to manage my mental health, in what ways may this impact a future pregnancy or is there anything I need to consider prior to getting pregnant?
Menstrual Health & Hormonal Concerns

I’ve been having irregular periods or cramps – should I be concerned, or is this normal?How can I manage severe period pain or symptoms that interfere with my daily life?If I suspect I have endometriosis or fibroids, what are the next steps for diagnosis and treatment?Should I be concerned about changes in my cycle as I get older (like missed periods, heavier or lighter flow)?How do I know if I need treatment for conditions like PCOS or abnormal bleeding, and what are the options?
Menopause, Perimenopause, & Hormonal Health

What are the early signs of perimenopause, and how can I prepare for changes in my body?How can I manage menopausal symptoms like hot flashes, mood swings, or sleep issues?What’s your advice on hormone replacement therapy (HRT)? What are the risks and benefits for me?How do I know when I’m approaching menopause, and what screenings should I get during this stage of life?If I’m already in menopause, are there any additional health concerns I should be aware of (bone density, heart health, etc.)?
General Health & Preventive Care

What preventive screenings should I be getting based on my age, family history, and lifestyle?Should I be worried about things like weight gain, fatigue, or changes in my skin or hair?Are there lifestyle changes I should be making to improve my overall reproductive health (exercise, diet, supplements)?What vaccines or boosters should I be getting, especially if I’m planning on becoming pregnant later?Are there any particular signs or symptoms I should watch for that might indicate more serious issues?How can I support my mental health in relation to reproductive care, especially if I’m dealing with stress or family planning challenges?
Sexual Health & Wellness

What’s the best way to maintain vaginal and sexual health? Are there any new treatments or recommendations?Should I be screened for sexually transmitted infections (STIs), even if I don’t have symptoms?How often should I get tested for STIs, and what screenings are important for someone like me?Are there any lifestyle habits that could affect my sexual health, and how can I improve them?Do you have any suggestions for managing sexual health during menopause, especially if I’m experiencing dryness or discomfort?
Legal & Privacy Concerns

What privacy measures does your office take to protect my reproductive health data, especially with digital health records?How do you handle referrals if I need out-of-state abortion care or other reproductive health services?What steps are you taking to protect patient confidentiality if new laws affect reproductive health care or access to services?What rights does my partner have when it comes to my medical care? How are the decisions that I make kept private?
Surgical Procedures & Future Planning

Should I consider freezing eggs or embryos, and how do I go about that process?If I’m considering surgery for conditions like fibroids or endometriosis, what should I know about my options?If I’m diagnosed with a condition that could affect my fertility, what steps should I take now?What is the process if I want to consider sterilization (like a tubal ligation), and what should I know before making this decision?Do you have any restrictions or requirements on sterilization or could I proceed with that if desired?
Gender Affirming Care

How might changes in laws or regulations affect my access to gender-affirming treatments, like access to puberty blockers, hormone therapy, or surgeries in this state?If restrictions are implemented, will there be alternative ways to access gender-affirming care, such as telehealth or out-of-state options?Can you help me understand any documentation or steps I can take now to ensure continuity of my gender-affirming care if policies change?What legal protections, if any, do I currently have in this state regarding gender-affirming care, and how might they be impacted by political shifts?Are there advocacy groups or resources you recommend that can keep me informed about changes to gender-affirming care policies?If insurance coverage changes, what financial resources might be available to help cover the costs of my care?
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