Create Your Take to the Doctor Sheet

Please fill out the below form to get a customized sheet that you can take to your next doctor’s appointment. This sheet will have all of the questions and details you need to help have a more informed conversation with your doctor*.

Please list all current medications, even over the counter and vitamins.
Why have you made this appointment? Is it follow-up or new care?
What symptoms are you currently experiencing?

*This tool does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the Your Vesa site. If you think you may have a medical emergency, immediately call your doctor or dial 911. This tool is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on Your Vesa! If you think you may have a medical emergency, call your doctor or 911 immediately. Your Vesa does not recommend or endorse any specific products or services. Reliance on any information provided by Your Vesa is solely at your own risk. We keep your data safe and secure. We will never sell your data for any purposes.

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