HealthRX.com · Printable question sheet
Metformin for weight maintenance questions for your prescriber
Use this sheet before a visit about metformin for weight maintenance, which is off-label. Fill in your details, bring it to your prescriber or pharmacist, and track stomach symptoms and other effects between visits.
About my prescription
Write what you know. Leave blank anything you are unsure of.
Medicine name on my prescriptionCopy it from the bottle or pharmacy label
Tablet formImmediate-release, extended-release or not sure
Condition the prescriber listedFor example diabetes, prediabetes or weight
Reason I was given for startingIn your own words
Other medicines I takeInclude insulin or sulfonylurea if any
Date of last kidney test
Date of last vitamin B test
Before the visit
Bring this sheet with the items below.
- Bring the pill bottle or a list of every medicine you take
- Write down the date you started metformin and any dose changes
- Bring your weight records from home or the clinic
- Note the dates and results of your kidney and vitamin B tests
- Check with the pharmacist which tablet form is dispensed
- List any alcohol use, surgery or imaging planned soon
- Confirm who to call after hours if you feel unwell
Questions to ask
- Is metformin prescribed for my condition, and is that use labeled for me?
- Which tablet form am I getting, and why was it chosen for me?
- When is my next kidney test, and what result would change the plan?
- How often should my vitamin B level be checked, and what happens if it is low?
- Which symptoms mean I should call you the same day?
- If I take insulin or a sulfonylurea, how will my blood sugar be watched?
- At my next visit, can we review whether continuing still makes sense for me?
Symptoms and weight between visits
Write what you notice. Share the sheet with your prescriber.
| Date | Stomach or bowel symptoms | Alcohol or illness that day | Weight on my scale | Notes for my 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.