As a patient, you will want to make the most of your doctor's visit. Take a few minutes to answer these questions prior to your doctor's visit. This will help you remember all that you want to ask and discuss with the doctor. (If you are a caregiver for an older adult, you may also want to review this checklist if you will assist the individual at the doctor's office.)

Before your appointment, fill in Table 1, Table 2, and Table 3 with any prescription drugs, over-the-counter drugs, or vitamins and supplements that you take on a regular basis. These tables will help the doctors know what medications and supplements you are taking and when you are taking them so the doctor can look for drug interactions and other problems caused by medications and supplements. For example, if you are having trouble sleeping and take a medication in the evening, the doctor might recommend you take it in the morning.

Space for taking notes during your visit is included at the end.

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Date: ___________

What is your primary reason for this appointment? Describe the symptoms or problems you are having?

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Is this a new problem or symptom? ________________________________________________

When did you first notice this problem or symptom? ___________________________________

How long does the symptom or problem last? Is it constant or only sometimes?

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When are the symptoms most noticeable? What treatments have you tried, if any, and have they helped? Describe how this is affecting your daily life.

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