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Information and Tools for Patients

My Medications List

Use this form to list all of your current medications, including non-prescription medications and herbal supplements and vitamins. Bring this form with you to all clinic visits so that your health-care provider will be aware of the medications that you take.

This form is available in two formats: Adobe Acrobat (pdf) and Microsoft Word (doc).

The Adobe Acrobat version requires Acrobat Reader which is available for free from Adobe. Click here to download Acrobat Reader. The Acrobat version can be printed on your printer and filled out by hand. It cannot currently be filled out on the computer. Click here to download the Acrobat version of My Medication List.

The Microsoft Word version requires that you have a current version of Word installed on your computer. This version can be filled out on your computer and printed on your printer. It can also be saved to your computer so that you can print another copy at a later time or so that you can make changes to your medication list.  Click here to download the Word version of My Medications List.