Free appointment schedule template 07
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Alabama DOH Title X Program Quality Improvement Institute –
Appointment Scheduling Worksheet 2

Purpose: Consider how access to family planning services is shaped by the number of appointments
available for family planning services within a given health center setting.
Instructions: Complete a separate table for each day of the week that services are available [circle the day
of the week in space provided below]. In the table provided below in the first row please list the types of
appointments available for the given day [example: Title X MD, Title X RN, WIC, STD/TB, FP Initial, FP
Annual, Immunization etc.]. For each type of appointment, please list, the average number of
appointments available on the schedule template for that visit type by hour of the day in the space
provided.
SITE NAME: ___ ________________________________________________
DAY: Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Summary of Patient Appointments Available by Day per Hour

TIME

APPOINTMENT TYPE