Drug Safety Questionnaire + Medical History

Our free drug safety questionnaire helps you get critical information from your doctor or pharmacist.

Download it from our store, print the questionnaire, take it with you, and have the doctor or pharmacist fill it out for each of your medications.

The second page has the Medical History form to share with your health care provider. Be sure to take it with you wherever you go, since you never know when you might need the information.