Medication review

Do you understand the reason why you are taking each of your medications? *

Do you understand how to take each of your medications? *

Are there any barriers you have with taking your medication? *

Are you currently taking each of your medications as they are prescribed on the label? *

Do you get any side effects from the medication you are taking? *

Do you take any other medications (including supplements or herbal remedies) that have not been prescribed? *

Are there any of your prescribed medications you feel you no longer need or have already stopped? *

Smoking Status: *

Do you have any other concerns relating to any of your medications? *