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Drug Safety Questionnaire + Medical History

Availability: In Stock
Reduced Price $0.00 Regular Price $3.50

Quick Overview

Get critical information from your doctor or pharmacist. Download and print the free drug safety questionnaire, take it with you, and have the doctor or pharmacist fill it in.

Product Description

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.

Product Reviews

  1. Drug Safety Questionnaire + Medical History

    Heide Kaplan
    Delray Bach, FL

    Very helpful and will keep it handy. Thank you

  2. Ms

    R. Miller

    Thank you. It`s a very good idea to review and be your own advocate of your own medical issues, as well as monitoring the medication consequences to stay healthy.

  3. drug safety & medical history downloads

    P. C.

    This is a great tool for the consumer. It gives focus to the important information patients need to know & be able to relay. This was offered free of charge.
    What a great service/a great thing to do.

    The people’s pharmacy is a very helpful, reliable and honest source of information!

  4. My medical history and drug safety questionaire

    Beverly Theresa G.
    New York

    It’s very good to have, especially the medical history and drug safety questionnaire.I made an extra copy of both. I filled out the my medical history and taped it to the inside of my kitchen cabinet. In case I ever get sick or need an ambulance the information will be readily available. I will take a copy of the drug safety questionnaire to the doctor with me next time I go in case he prescribes any new medication for me.


    Amy Brinckerhoff
    Dover NH

    I have been doing something similar for years. It’s tough to get compliance from druggists and doctors and their staffs, but maybe your putting this in everybody’s hands will make it easier for us all.

    Unfortunately, I’m having a problem printing it out. I’ve tried EVERYTHING I can think of … even tried to convert it to “Word” but they wanted to charge me a monthly fee and I have little use for it other than this download. I used to get things from you sent via snail mail and I’d be glad to pay for that privilege, but I’m through wasting my time trying to print this. Sorry.

  6. Drug and safety questionnaire

    Robin Yost
    Concho Arizona

    I think this is a great tool and will be very helpful

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