A Printable Medicine and Supplement List to Bring to Appointments
A printable medicine and supplement list to fill in and bring to appointments, with fields from NIH and FDA advice and a short guide to filling it in.
Content last updated . This page has not been medically reviewed.
To print: use your browser's Print command (Ctrl+P or Cmd+P) on this page, then fill it in by hand. Nothing you write here is saved or sent anywhere.
Emergency first: call 911 for collapse, seizure, trouble breathing or swelling of the face or throat. Call 988 for a mental health crisis (US). Call Poison Help at 1-800-222-1222 for a possible poisoning (US). This list is for planned visits.
Why keep a list
NIH and the FDA both advise bringing a written list of everything you take to each visit. [1] [2] The National Institute on Aging suggests keeping one copy at home and one in your wallet or purse, and showing the list to all your health care providers, including physical therapists and dentists. [3] Update it at every visit. [1]
What to write down
NIH asks for the prescription and over-the-counter medicines you take, including supplements, how often you take them and the doses. [1] The National Institute on Aging adds the name of each product, and for prescriptions, the doctor who prescribed it and the reason. [3] The columns below follow that advice. Columns marked "our suggestion" are not from the sources.
Write amounts exactly as they appear on the package or in your prescriber's instructions. Do not guess. A clinician or pharmacist decides what is right for you.
Part 1: Prescription and over-the-counter medicines
| Name on the package | Amount and how often | Prescribed by / reason | Started (our suggestion) |
|---|---|---|---|
Part 2: Vitamins, minerals, herbs, teas, oils and other natural products
Include every form: pills, capsules, powders, gummies, teas, tinctures and oils. The National Institute on Aging says to mention everything, even products you use infrequently. [3]
| Product name and form | Main ingredients listed (plant name and part, if shown) | Amount and how often | Why I take it (our suggestion) |
|---|---|---|---|
If the package has a Supplement Facts panel, copy the ingredient names from it, or bring the package. NIH says bringing the bottles can help your provider answer questions about ingredients. [1] For help reading a label, see reading supplement labels.
Part 3: Allergies and past reactions
| Product or substance | What happened |
|---|---|
The National Institute on Aging suggests discussing allergies and problems you have had with other medicines, such as rashes, trouble breathing, indigestion, dizziness or mood changes. [3]
Part 4: Health changes to mention
The FDA asks you to tell your health care professional if your health status has changed, particularly if you are pregnant, breastfeeding, or have had a recent illness or surgery. [2]
| ☐ | Item |
|---|---|
| ☐ | Pregnant, breastfeeding or trying to get pregnant |
| ☐ | Recent illness or surgery |
| ☐ | New symptoms since my last visit |
| ☐ | Planned surgery, dental work or a procedure |
| ☐ | Anything I stopped taking, and when |
Part 5: Questions for this visit
- ____________________________________________
- ____________________________________________
- ____________________________________________
See what to ask for a starting list.
Using the list
- Hand it over at the start of the visit, not the end.
- For surgery or a procedure, give it to the surgical and anesthesia teams. See how to prepare your supplement list for a procedure.
- Do not stop or change a prescribed medicine because of anything on this page. Ask the prescriber or pharmacist.
Frequently asked questions
Do I list vitamins and herbal teas too?
Yes. NIH's request covers supplements as well as medicines. [1] The National Institute on Aging says to include any vitamins or dietary supplements. [3]
Should I write down the dose?
Yes, copy it from the package or prescription. NIH asks for how often you take each product and the doses. [1] This page does not suggest any amounts.
How often should I update it?
NIH says to update the information each time you visit the provider's office. [1]
Where do I keep it?
The National Institute on Aging suggests one copy in a safe place at home and one in your wallet or purse. [3]
Who should get a copy?
All your providers. The National Institute on Aging says to show it to all of them, including physical therapists and dentists. [3] For more on whom to tell, see questions to ask your pharmacist and how to tell your doctor.
References
- National Center for Complementary and Integrative Health (NIH, US). Know the Science: Talk With Your Health Care Providers. Read 2026-10-23.
- U.S. Food and Drug Administration. Mixing Medications and Dietary Supplements Can Endanger Your Health (consumer update, content current as of 2022). Read 2026-10-23.
- National Institute on Aging (NIH, US). Taking Medicines Safely as You Age. Read 2026-10-23.