Every health-related concern you have matters, so try to avoid saying that you’re doing “fine.” To help organize your thoughts, you can create your own doctor discussion guide below.
GET A CUSTOMIZED DOCTOR DISCUSSION GUIDE
When talking to your doctor, it’s important that you don’t miss anything. Heart Failure symptoms increase the risk of death and hospitalization, but they often go unnoticed. Go over symptoms, physical activities, and previous appointments. It can make all the difference.
Complete the form below to get a doctor discussion guide that is specific to you.

I am experiencing
shortness of breath
New
Ongoing
Worsening

I am experiencing
coughing
New
Ongoing
Worsening

I am experiencing
swelling
New
Ongoing
Worsening

I am experiencing
confusion or memory loss
New
Ongoing
Worsening

I am experiencing
fatigue
New
Ongoing
Worsening

I am experiencing
rapid weight gain
New
Ongoing
Worsening
Are you experiencing any other new or ongoing symptoms?
Share your progress
In addition to keeping up with treatment, making healthy lifestyle
changes is also important for people with Heart Failure.
In addition to keeping up with treatment, making healthy lifestyle changes is also important for people with Heart Failure.
Have you made any changes to your diet?
Yes
No
Have you been able to get out and stay active?
Yes
No
What can you NOT do today that you could do 3 months ago, or since your last appointment?
For example: Are you not sleeping as well? Are you unable to walk as far as you once could? Do you have trouble carrying your grocery bags?
Over the last 3 to 6 months, what events have you had to miss because you were not feeling well?
For example: Have you been unable to attend a wedding or go on vacation?
Have you been hospitalized because of Heart Failure? If yes, make sure you bring any medications you’re taking when you show up for your next doctor’s appointment.
Yes
No
If yes, were you prescribed new medications in the hospital? List them here:
Make sure you know your medicines
Understanding what each medicine does and why the doctor recommended you take it is important. These questions can help you get to know them better.
What are the most important things I should know about taking my Heart Failure medicine?
Are there any medicines I should not take while taking my Heart Failure medicine?
How will I know if my Heart Failure medicine is working?
How can I save money on my Heart Failure prescription?
Does my Heart Failure medicine come with a patient support program?
Additional questions to remember and discuss with your doctor
Of course, you may have other questions that are not on this list.
If there’s anything else you’d like to ask your doctor, type it here: