Make room for
your questions.

Before I go

• My current medication list and medication containers, if possible
• Names of nonprescription products, vitamins, and supplements
• Allergies, reactions, and questions about side effects
• Blood-pressure or glucose records, if I already track them for my care
• A trusted support person, if I want one involved

What I want to ask

1. My most important question:

2. Something I do not understand:

3. Something making my routine difficult:

Before I leave

• Ask which medicines or instructions have changed.
• Explain the plan in my own words and check that I understood it.
• Ask who to contact with questions and when to follow up.
• Ask for written instructions I can understand.

My next step and who to contact:

An education and organization tool, not a substitute for medical care.

Informed by AHRQ’s teach-back guidance. Resource prepared September 29, 2026.