Patient Questionnaire: What My Doctor Should KnowMy Doctor Discussion Checklist: What I Want to Talk About

Choose your answers below. Your responses will be included in your personalized discussion guide.
Check the box next to the topic you want to discuss with your doctor to have it included on your personalized checklist.

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You should also discuss the following with your doctor, in as much detail as possible. This will help your doctor customize your treatment plan:

  • The names and dosages of any medications and nutritional supplements that you take (including vitamins, herbs, etc.)
  • Your previous experience with pain and/or pain medications after surgery
  • Any other health conditions you may have, including asthma, COPD, gastrointestinal problems, past or present heart, liver or kidney disease, enlarged prostate, and sleep apnea
  • If you are pregnant or may become pregnant
  • Your occupation and home life in terms of activity levels and responsibilities
  • Any other personal or family history you feel may be relevant, including any history of substance abuse