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Personal Health Canvas

Know your health — even without a doctor.

Without a family doctor, no one is tracking your health for you. This one-page tool helps you take stock — your conditions, medications, care team, screening status, and next steps. Print it, fill it in, and bring it to any provider you see.

or use File → Print in your browser

Why this matters: If you can't answer a question in one of the sections below, that's a gap — and gaps are risks. An unknown medication reason, a missed screening, an overdue referral. The goal isn't to fill every field perfectly on the first try. It's to identify what you don't know, so you can find out.

Developed by a GTA family physician through Building Block Health. Read the clinical rationale: Reimagining the Annual Health Exam →

01

About Me

Basic information that any clinician needs at a first visit — and that you should have ready in an emergency.

Full name
Date of birth
Health card number (OHIP)
Known allergies (medication, food, other)
Emergency contact name and phone number
Preferred language
Preferred pharmacy
02

My Conditions

Knowing your diagnoses by name — not just the medications you take for them — helps every clinician who sees you understand your health story quickly.

💡 If you're not sure of a diagnosis, ask at your next walk-in visit: "Can you tell me what condition this is called?"

Condition / diagnosis
When identified (approx.)
Current status (ongoing / managed / resolved)
Condition / diagnosis
When identified (approx.)
Current status
Condition / diagnosis
When identified (approx.)
Current status
Past surgeries or hospitalizations
03

My Medications

Every clinician you see — walk-in, specialist, ER — will ask for this list. Knowing the name, dose, and reason for each medication can prevent dangerous errors.

💡 Ask your pharmacist for a printed medication list. They can generate one for you at any time.

Medication name
Dose
How often
What it's for
Medication name
Dose
How often
What it's for
Medication name
Dose
How often
What it's for
Medication name
Dose
How often
What it's for
Over-the-counter medications or supplements taken regularly
04

My Care Team

Even without a family doctor, you may have clinicians involved in your care. Knowing who they are and when you last saw them helps you stay connected and avoid gaps.

Clinician name
Role (e.g. cardiologist, physiotherapist)
Last visit / next appointment
Clinician name
Role
Last visit / next appointment
Clinician name
Role
Last visit / next appointment
Clinic or hospital most recently used for urgent care
05

My Screening Status

Ontarians without a family doctor are significantly less likely to be up to date on cancer screening — not because they didn't want to be screened, but because no one prompted them. This section helps you identify the gaps.

💡 Not sure how to access screening without a doctor? Want to learn more about these tests and their purpose? Visit the Unattached Patient Guide →

Colorectal cancer (FIT kit, ages 50–74)
Last done / not yet done / not applicable
Breast cancer (mammogram, ages 40–74)
Last done / not yet done / not applicable
Cervical cancer (HPV test, ages 25–69)
Last done / not yet done / not applicable
Lung cancer (LDCT, ages 55–80 with smoking history)
Last done / not yet done / not applicable
Bone mineral density (ages 65+, or 50+ with risk factors)
Last done / not yet done / not applicable
Abdominal aortic aneurysm ultrasound (ages 65–80)
Last done / not yet done / not applicable
Blood pressure (most recent reading and date)
Bloodwork (most recent date and where done)
Vaccinations — list any you know you've received (e.g. flu, COVID, shingles, Tdap)
06

My Next Steps

This is the most important section. Gaps and overdue items are risks — writing them down is the first step to addressing them. Bring this list to your next clinician visit.

💡 A walk-in clinic can help with many of these: ordering bloodwork, writing referrals, providing requisitions for imaging, and initiating screening.

Pending referrals or specialist appointments
Overdue screening or tests I need to follow up on
Medications I need reviewed or renewed
Questions I want to ask at my next clinician visit
Other health goals or concerns I want to address

Found a gap? Here's what to do.

→
Missing screening: Most Ontario screening doesn't require a family doctor. Visit openprimarycare.com/guide for step-by-step access to FIT kits, mammograms, cervical screening, and more.
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Need a referral or bloodwork: Walk-in clinics can order standard bloodwork and write referrals to specialists — you don't need a family doctor for this.
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Don't have a family doctor at all: Visit openprimarycare.com/find for search tools, provincial waitlists, and your local Ontario Health Team intake.
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Medication questions: Your pharmacist can review your medications, explain interactions, and treat 19 minor conditions under Ontario's Minor Ailments Program — no appointment needed.
Help us improve this tool

This canvas is in active development. If you're an unattached patient — or a clinician who works with them — your feedback on what's useful, what's missing, or what's confusing would directly shape the next version.

Share your feedback →