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Being better prepared may help you feel better.

The more information you give your doctor about your symptoms, the better. That’s why we created this Conversation Guide for you. Interact with it. Jot down a few notes. Then print or download this guide before your visit to the doctor. This is for your personal use. We will not use this information. After all, the more prepared you are, the more productive your visit will be.
  1. I suffer from heartburn or more time a week.

  2. My heartburn occurs most often:
    During the day After meals When I go to bed
    When I exercise When I bend over

  3. Here’s how my symptoms are affecting my daily routine:


  4. I am taking the following over-the-counter and/or prescription
    heartburn medications:

  5. Have there been any major changes in your life recently? Yes  No
    If you answered Yes, enter what has changed.

  6. List any other medication you are taking in addition to your
    heartburn medication.


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