Patients often arrive at brief, time-constrained clinical visits unsure of what to expect or ask, and millions of adults now turn to general-purpose AI chatbots to prepare beforehand. Yet whether conversational AI improves visit readiness remains unclear. We designed a large language model (LLM)-based visit preparation agent to guide patients before an appointment by gathering clinical context, setting visit expectations, providing relevant health information, building a prioritized list of questions for their clinician, and generating a summary. In a prospective consented randomized study in the Google Health app, 802 U.S. adults held 866 health-related conversations with the visit preparation agent (standard or concise variant) or a minimally prompted control chatbot built on the same LLM. The visit preparation agent significantly outperformed the control across blinded clinician evaluations and patient self-reports. In clinician reviews of completed sessions (n = 272), the agent achieved a 16.6% higher rate of comprehensive preparation (67.2% vs. 50.6%; P < 0.05) and an 8.5% higher rate of alignment with patients' health context (98.9% vs. 90.4%; P < 0.01), while maintaining high medical safety and appropriateness across all study arms. Patient post-surveys (n = 460) showed 16.8% higher visit preparedness (73.8% vs. 57.0%; P < 0.01), 14.3% higher confidence in knowing what to ask (81.4% vs. 67.1%; P < 0.01), and 12.0% higher overall satisfaction (74.0% vs. 62.0%; P < 0.05). Clinician and participant metrics were not significantly correlated, indicating that expert review and patient self-assessment capture complementary dimensions of patient-facing AI. These findings suggest that LLM chatbots can safely help patients prepare for clinical visits, with greater benefit when following a structured workflow, and motivate future studies on in-visit communication and clinical outcomes.

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