Private appointment worksheet

Bring a clear timeline to a clinician

Psychosis can make a long story feel urgent and interconnected. A concise timeline helps a clinician evaluate safety, sleep, mood, substances, medicines, medical causes, and changes from your usual functioning.

Do not wait for an appointment during an emergency

Call the local emergency number or go to an emergency department for immediate danger, a suicide plan, a weapon, a dangerous confrontation, severe confusion, seizure, fever, sudden weakness, head injury, overdose, dangerous withdrawal, or a rapid postpartum mental change.

1. Appointment and contact information

Include only information you are comfortable storing in this browser.

Name or preferred name

Appointment date

Clinician or clinic

Trusted person attending or available

2. What changed, and when?

Describe observable changes. Exact dates are helpful, but an approximate sequence is still useful.

Earliest change from usual behavior or thinking

Speed of onset

Usual functioning before this change

Short timeline of major events

3. Sleep, mood, and energy

Changes in sleep and energy can help distinguish mania, depression, trauma, substance effects, delirium, and other causes.

Sleep during the last seven days

Mood and emotional changes

Energy, speech, and activity

Effects on daily functioning

4. Unusual experiences and beliefs

You do not need to persuade the clinician of a theory. Describe what you experienced, how certain it felt, and what it led you to do.

Beliefs about surveillance, missions, coded messages, special status, punishment, or control

Voices, visions, sensations, or perceived communications

Personal meanings in ordinary events

Actions driven by these experiences

5. AI, internet, and digital use

Include this section when a chatbot, forum, video, or algorithm became part of the experience.

AI or online session pattern

What the system appeared to say or confirm

Real-world changes after the interaction

6. Medicines, substances, and physical health

Bring medication containers or a current pharmacy list when possible. Do not stop a prescribed medicine abruptly without professional guidance.

Prescriptions, over-the-counter medicines, hormones, and supplements

Alcohol, cannabis, stimulants, psychedelics, sedatives, or other substances

Medical and neurological symptoms

Pregnancy, childbirth, or hormonal context if relevant

7. Trauma, stalking, abuse, and proportionate verification

Real stalking, coercive control, discrimination, fraud, and privacy violations can occur. Separate concrete observations from broader interpretations.

Trauma or coercive-control history relevant to current fear

Specific observable events

What has been reviewed, by whom, and the result

Checking or investigation behavior

8. Safety and immediate risks

Be direct. This information helps the clinician choose the safest level of care.

Thoughts of suicide, self-harm, or escaping capture

Thoughts of confronting or harming someone

Food, water, housing, driving, dependents, and essential medicines

Protective people, responsibilities, and reasons to accept help

9. Previous episodes and what others noticed

Previous similar episodes or diagnoses

What helped or made things worse before

What a trusted person has noticed

10. Questions for the clinician

Questions and priorities

Keep the first conversation focused

Lead with safety, onset, sleep, and function

State the main change. “This began suddenly three days ago,” or “This has grown over six months.”
Report sleep and risk. Include no-sleep nights, suicide thoughts, weapons, driving, travel, food, and medication refusal.
Give the timeline. Describe beliefs and voices after the clinician understands the course and urgent risks.