🖨️ Print-Friendly Guides

This page contains large-print templates you can print at home and bring to appointments. They are designed for older adults and caregivers in Canada.

🖨️

How to Print

Click the "Print this page" button below to print all guides at once, or scroll down to print individual sections.

📋 Available Guides

💊 Medication List Track all your medications ❓ Appointment Questions Questions to ask your doctor 📝 Symptom Diary Track symptoms and changes 🩸 Blood Pressure Log Record your BP readings 🍬 Blood Sugar Log Track glucose levels 🚨 Emergency Information Important contacts and info

💊 1. Medication List Template

Use this table to write down all medications, vitamins, and herbal products. Bring it to every appointment and to the pharmacy.

Name: ________________________________________________

Date of Birth: ________________________

Health Card #: ________________________

Medication Name	What It's For	Dose / How Often	Prescribing Doctor	Start Date

Allergies or Reactions:

_______________________________________________________________

Pharmacy Name & Phone: _______________________________________________

❓ 2. Appointment Questions Checklist

Before your visit, check the questions you want to ask. Add your own questions in the blank spaces.

Appointment Date: ___________________ Time: ___________

Doctor/Clinic: ________________________________________________

Reason for Visit: ________________________________________________

Questions to Ask:

☐ What is the main problem we are dealing with today?

☐ What are the options for treating this problem at my age and health?

☐ What are the benefits and risks of each option?

☐ How will we know if the treatment is working?

☐ What side effects should I watch for at home?

☐ Are any of my current medications no longer needed?

☐ Are there foods, drinks, or over-the-counter products I should avoid?

☐ Who should I contact if I have questions after I go home?

☐ When should I schedule a follow-up appointment?

My Own Questions:

1. ____________________________________________________________

2. ____________________________________________________________

3. ____________________________________________________________

4. ____________________________________________________________

Notes from the Appointment:

_________________________________________________________________

📝 3. Symptom & Side Effect Diary

Use this table to track symptoms, side effects, or changes you notice. Bring it to appointments so your provider can see patterns over time.

Name: ________________________________________________

Week of: ________________________

Date	Time	What I Noticed (symptom or side effect)	What I Was Doing / Medication Taken

Questions to discuss with my provider:

_______________________________________________________________

🩸 4. Blood Pressure Log

Record your blood pressure readings to share with your doctor. Take readings at the same time each day if possible.

Name: ________________________________________________

Target BP (if given by doctor): _______/_______

Month/Year: ________________________

Date	Time	Blood Pressure	Pulse	Notes (how you feel, missed meds, etc.)
		____/____
		____/____
		____/____
		____/____
		____/____
		____/____
		____/____
		____/____
		____/____
		____/____

Tips for Accurate Readings:

Sit quietly for 5 minutes before taking your reading
Don't drink caffeine or exercise 30 minutes before
Sit with feet flat on floor, arm supported at heart level
Take 2 readings, 1 minute apart, and record the average

🍬 5. Blood Sugar Log

For people with diabetes. Record blood sugar readings to share with your healthcare team.

Name: ________________________________________________

Target range (if given): _______ to _______ mmol/L

Week of: ________________________

Date	Before Breakfast	After Breakfast	Before Dinner	After Dinner	Bedtime

Low blood sugar episodes (date, time, symptoms):

_______________________________________________________________

Notes for my healthcare team:

_______________________________________________________________

🚨 6. Emergency Information Card

Fill out and keep in your wallet or on your fridge. Make sure family members know where to find it.

🚨 EMERGENCY INFORMATION

Name:

_________________________________________

Date of Birth:

_____________________

Health Card #:

_____________________

📞 Emergency Contacts

Contact 1:

_________________ Phone: _________________

Contact 2:

_________________ Phone: _________________

👨‍⚕️ Healthcare Providers

Family Doctor:

_________________ Phone: _________________

Pharmacy:

_________________ Phone: _________________

⚠️ Medical Conditions

_______________________________________________________________

💊 Current Medications

_______________________________________________________________

🚫 Allergies

_______________________________________________________________

Tip: To save paper, you can also print individual sections using the buttons above each guide.

⚠️ Important

These print-friendly guides from SeniorHealthGuide.ca are for general education only and may not fit your exact situation. They do not replace medical advice, diagnosis, or treatment.

Only health professionals who know your medical history can tell you what is right for you. Always follow the instructions given by your own doctor, nurse practitioner, or pharmacist.

For full details, see our disclaimer.