mind alive David - PERSONAL PROFILE QUESTIONNAIRE; VII. MEDICATIONS

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PERSONAL PROFILE QUESTIONNAIRE
VII. MEDICATIONS
Make a list of the pharmaceutical drugs that you are taking or have taken in
the past 6 months:
Condition
Medication
Diabetes
Thyroid
ADD/ADHD
Hypertension
Asthma
1) What have you done to feel better?
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
2) Have you visited a doctor, specialist or have you been in the
emergency room due to any of these symptoms?
 Yes
 No
If “Yes”, what was done to help you feel better?
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________