I have a medical need.

What is the nature of your problem or issue?

Is this a follow-on problem which the Doctor knows about? If yes state Dr name

How long have you had the problem?

What are your ideas about what's happening? What do you think it is?

What are your concerns - what is worrying you about this?

What are your expectations - what would you like to see happen?

Anything else you would like to add?