Clemens Health | First-visit preparation note
Updated 2026-10-05 | (651) 354-1196

Download this editable worksheet, add your notes, and bring it to the relevant planning conversation. Leave unknown details blank and identify who can confirm them.

Appointment purpose
Is this an introduction, planning conversation or confirmed service visit?
Your notes: ________________________________________

Arrival agreement
Who is coming, at what time, and who should be contacted about a change?
Your notes: ________________________________________

Person’s introduction
What do they want the worker to know, and what do they want to explain themselves?
Your notes: ________________________________________

Routine and boundaries
Which activity is agreed, and which requests still need clarification?
Your notes: ________________________________________

Follow-up
How will the person share feedback, and who will act on it?
Your notes: ________________________________________

Illustrative example
A person wants to show a new worker their usual afternoon routine. Their sibling writes a long history, but the person chooses a short introduction and asks the sibling to join only for the final questions. That preference becomes part of the visit discussion.

Next step
Confirm the visit details with the provider and keep the coordination contact easy to find. Bring unresolved service questions back to the case manager.

This is an optional discussion worksheet, not an official assessment, authorization, service plan, or emergency plan. Keep completed copies private and share through an agreed channel.