Medication Question Form
Ask your health care provider these questions about each new medicine which is recommended or prescribed.
Write the answers in the spaces provided.
Use a separate sheet for each medicine.
Name of Medicine: _________________________________________________
- What are the brand and generic names of the medicine?
- Can I use a generic form?
- What is the medicine for and what effect should I expect?
- Does this drug replace any other medicine I have been using?
- How and when will I use it, what amount will I use, and for how long?
- What do I do if I miss a dose?
- Should I avoid any other medicines, (prescription or over-the-counter), dietary supplements, drinks, foods or activities while using this drug?
- When should I notice a difference or improvement?
- When should I report back to the team?
- Will I need to have any testing to monitor this drug's effects?
- Can this medicine be used safely with all my other medications and therapies?
- Could there be interactions?
- What are the possible side effects?
- What do I do if a side effect occurs?
- How and where do I store this medicine?
- Where and how can I get written information about this medicine?
- What other sources of information can I use to make my decision?