DBQ appointment planner

Prepare your observations, records list, and questions for a clinician who may complete a Disability Benefits Questionnaire.

What you will make

Make a practical visit plan with your observations, a records index, and questions for the office. The clinician completes any clinical findings and certification on the appropriate official form.

Read the preparation guide and official sources
Free • Runs in your browser

Building and editing stay in your browser. Copy or download before leaving. Your entries are not sent to our server or an AI provider.

Leave unknown details blank; the worksheet will mark them for review. Do not include a Social Security number, VA file number, date of birth, address, or medical records. This worksheet does not create a medical opinion.

Your editable appointment plan

Local worksheet

Review carefully. A worksheet is a draft, not a signed statement or a completed VA submission. You decide how to use it.