Questions for your doctor

Create a customized discussion guide for you and your doctor

A good working relationship with your doctor is vital to the success of any treatment plan.

To help get the conversation started, you can create a personalized list of questions and concerns by simply clicking the boxes next to the items that are most important to you. Then print the list out and take it to your next doctor's visit.

I'm having problems with dry mouth. Could I have Sjögren's syndrome?
I have these other symptoms. Could they be related?
Reduced saliva flow
Trouble speaking
Problems chewing
Trouble swallowing
Cracked lips
Trouble eating
Other
I drink about glasses of water a day. Is that a lot?
My dry mouth is affecting these things that I do every day:
Swallowing
Tasting
Chewing
Talking
Other
I'm coping with my symptoms of dry mouth by:
Always carrying bottled water
Chewing gum
Sucking on candies
Taking over-the-counter saliva substitutes
Taking prescription medicine
Other
What else can I do or try to help relieve my symptoms of dry mouth?
Besides you, I also see the following healthcare professionals:
Primary care provider
Rheumatologist
Ear, Nose and Throat
Ophthalmologist
Dentist
Other
Other
1 2 3
I am taking the following prescription and over-the-counter medicines.

Is it OK to take EVOXAC while I am taking these other medicines?
Is EVOXAC right for me?


Other questions I have or things that I want to mention.

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