Current Medications Form Template

Collects current prescriptions, over-the-counter medicines, supplements, doses, schedules, and pharmacy details. Patients can share this information with a healthcare provider or care team.

Use this template free

When to use it

• Before a new patient’s first appointment
• When updating a medication list at a checkup
• Before a pharmacist reviews someone’s medicines
• When coordinating care between providers

What it asks

1. Your name
2. Email address
3. Phone number
4. What medicines and supplements are you currently taking?
5. What pharmacy do you use?

Why it should be encrypted

Medication lists can reveal health conditions and personal routines, while pharmacy details can identify where someone gets care. Only the intended care team should be able to read these answers.

Tips

• Ask people to include each medicine’s dose and how often they take it.
• Clarify whether to list occasional medicines and supplements.
• Tell respondents who will review their answers and how to contact them with updates.

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