HealthRX.com · Printable question sheet
Finasteride five-year study questions for your prescriber
Use this sheet before a visit with your prescriber or pharmacist about finasteride and the five-year hair study results. Fill it in by hand, bring it along, and keep a copy at home.
About my treatment
Copy these from my prescription label and my records.
Medicine name on labelWrite the name exactly as printed
Prescriber name and clinicDoctor or clinic that writes my prescription
Pharmacy name and phoneWhere I collect my medicine
Month and year treatment started
Area of hair loss I am treatingFor example top of head or front and sides, as my prescriber described
Ask at my next visit
- Which hair measure or photo method will be used to track my progress?
- Does my area of hair loss change how well this study results apply to me?
- What is expected to happen to my hair if I stop taking this medicine?
- How often should sexual side effects be checked during treatment?
- What should I do if a sexual side effect continues after I stop taking it?
- Should I discuss prostate screening with you given my age and this medicine?
- Will my pharmacist check this medicine against my other medicines and supplements?
- How long do you expect this treatment to continue for me?
Sexual side effects tracker
Write what I notice and when. Bring this page to visits. Use my own words.
| Date | What I noticed | How bothersome it was | Still present? | Who I told |
|---|---|---|---|---|
Things to bring and confirm
- Bring the medicine bottle or box so the name and label can be checked.
- List every other medicine and supplement I take on a separate sheet.
- Note the month I started and any gaps when I stopped taking it.
- Write down any changes in hair or side effects since my last visit.
- Confirm with the pharmacy how to reach them with questions.
- Ask my prescriber to write down the answers I receive on this sheet.
- Check with my insurer whether a copy of the prescription is needed for refills.
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.