Patient tools

Make the visit easier to use.

This browser-only tool keeps your entries on your device. It does not transmit, save, or place them in a patient record.

Fill it out, then take it with you.

Complete the three sections below. When your brief is ready, copy it and paste it into your doctor's patient portal, upload it there if your portal accepts a document, or print it and bring the paper copy.

You stay in control: nothing you type is sent to BKND, Modern Prostate Institute, or any doctor, and this page does not store your entries.

1. In one sentence, why are you going?

2. Which records do you already have?

Check each item you have, then use its extra-information line if a short, non-identifying note would help.

Prior PSA resultsExtra information for Prior PSA results (optional)

MRI report or imagesExtra information for MRI report or images (optional)

Biopsy/pathology reportExtra information for Biopsy/pathology report (optional)

Medication listExtra information for Medication list (optional)

Urinary symptom notesExtra information for Urinary symptom notes (optional)

Family history notesExtra information for Family history notes (optional)

3. What must be answered before you leave?

Your appointment brief

REASON FOR VISIT
Not entered

RECORDS I HAVE
None selected

QUESTIONS I WANT ANSWERED
Not entered

Nothing entered here is transmitted or stored by BKND or this site. Copying, portal upload, and printing happen only when you choose them.

Privacy boundary

Do not enter names, dates of birth, medical record numbers, full reports, or other identifying health information. BKND and Modern Prostate Institute cannot see what you type. Only copy, upload, or print the finished brief when you are ready to share it with your doctor.