Living Well With Rheumatoid Arthritis Questionnaire

Ask the Right Questions at
Your Next Doctor's Appointment

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Is this doctor’s appointment for yourself or someone else?

Myself
Spouse
Child
Parent
Friend or other relative

1 of 6

What is the reason for the appointment?

Routine visit
New or worsening symptoms
Medication issues or side effects
Second opinion
Evaluation for a possible diagnosis of rheumatoid arthritis

2 of 6

Has a doctor diagnosed you or your loved one with rheumatoid arthritis?

Yes, Diagnosed
No, Undiagnosed

3 of 6

Is the appointment with a current or new doctor?

Current doctor
New doctor

4 of 6

What are your symptoms? (Optional)

Morning joint stiffness
Joint redness, warmth, and tenderness
Joint pain
Joint swelling
Joints affect on both sides of body
Fever, fatigue, and weight loss

(add another?)

5 of 6

What medications are you taking (if any) for Rheumatoid Arthritis? (Optional)

6 of 6

This Guide Is Based On Your Answers

Appointment For:
Reason(s):
Diagnosis:
Care Provider:

@Your Appointment

for Rheumatoid Arthritis

Questions for Your Doctor

All Questions About Rheumatoid Arthritis

REMEMBER TO DISCUSS

Symptoms:

Medications:

REMEMBER TO BRING

Insurance Card and Info

Driver's License or ID

This Guide And Pen

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