HealthRX.com · Printable question sheet
Metformin for PCOS questions to bring to your prescriber
Use this sheet before or at a visit about metformin prescribed for PCOS, which is off-label. Fill it in by hand, bring it to your prescriber or pharmacist, or keep it at home to track side effects.
Your details for this visit
Copy these exactly from your bottle label or prescription record.
Name of prescriberDoctor, nurse practitioner or clinic
Name of pharmacist or pharmacy
Metformin product on your bottleImmediate-release or extended-release
Dose and schedule written on your label
Other medicines or supplements you takeInclude any myo-inositol or d-chiro-inositol
Date of your most recent kidney function test
Date of your most recent vitamin B level test
Bring or confirm before the visit
- Bring your metformin bottle and the pharmacy label
- List every prescription, over-the-counter medicine and supplement you take
- Note the date and result of your last kidney function test
- Check with your pharmacist whether your vitamin B level was measured recently
- Note any upcoming scan with contrast dye, surgery or procedure on your calendar
- Write down what you hope to change: cycles, weight, acne, hair growth or fertility
- Confirm whether you are planning a pregnancy or could become pregnant
- Bring the side effect log from this sheet if you have one
Questions to ask your prescriber or pharmacist
- Is metformin being prescribed off-label for my PCOS, and what is the main goal for me?
- Which of my PCOS concerns is this medicine expected to address for me?
- Which kidney function checks do you want for me, and when?
- When should my vitamin B level be checked while I take metformin?
- Should metformin be paused before any scan with contrast dye or any surgery I have planned?
- Would an inositol product be an option to discuss with you, and how would we compare results?
- What should I do if I have stomach symptoms that affect my daily life?
- What changes to my plan should I expect if I become pregnant or want to conceive?
Side effect and symptom tracker
Write each new symptom as it happens and bring this page to your next visit.
| Date | Symptom | Timing with meals | How bad | Told prescriber |
|---|---|---|---|---|
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.