Counseling is provided to patients by pharmacists or doctors to provide information about any medication they are taking. It is important that patients know the side-effects of the medication and what these will do to alleviate their symptoms and / or cure their diseases, as well as help them determine if they would need to make any lifestyle changes. Aside from that, people with behavioral or mental concerns can also seek counseling to help resolve those concerns. For these purposes, Counseling Forms are needed.

New Patient Counseling Form

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Counseling Patient Intake Form

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Size: 109 KB

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 Patient Profile Counseling Blank Sheet

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Patient Counseling Log Example

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Patient Medical Information Form

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Types of Patient Counseling Forms

  • New Patient Counseling Form: This form is filled out by a new patient who is seeking counseling for any behavioral or mental concerns. It contains information that can help their counselor or therapist understand their situation and what they wish to accomplish so that they can help them better. It may also contain insurance information, emergency contact information, and disclosure and / or consent forms. Aside from this form, you may also check out our other Counseling Application Forms.
  • Patient Profile Counseling Form: This contains a list of medication the patient is taking and any known allergies.
  • Patient Counseling Log: This is used to determine if counseling was done by a pharmacist for every medication the patient is taking. Information that should be included in the counseling are: the name and description of medication, dosage and route of medication, frequency of medication, instructions for missed dosage, common side-effects, interactions, proper storage, duration of therapy, refills, and other special instructions.
  • Pharmacy Patient Counseling Checklist Form: This form makes sure that all areas of the counseling and all needs of the patient are met.
  • Patient Agreement Form: This form is used to for patients who are starting a long-term medication with opioid analgesics and other controlled substances. These are medications that may cause addiction and should therefore be taken with caution. There are certain rules that a patient must follow in taking the medication, and in the event that he breaks any of the rules, the doctor may terminate the treatment but in a safe way. This form can be used for the patient and the health practitioner to communicate and voice out any questions or concerns the patient may have.

Pharmacy Patient Counseling Checklist Form

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Patient Counseling Intake Form in Word Format

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Free Patient Education Assessment Form

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Patient Agreement Form Example

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Importance of Patient Counseling

  • It helps the patient understand the importance of their medication. When they know how the medicine works, and what it will do alleviate their symptoms and cure their disease, they will know how important it is for them to take the medicine in the frequency prescribed by their physician. This will motivate them to regularly take the medicine.
  • It can help patients cope with possible side-effects and manage them properly.
  • The patient can understand the importance of their well-being and would therefore be an effective and involved participant in disease treatment and self-care management.

Because of patient counseling, patients are more aware and informed. This is why any healthcare facility or pharmacy would want to use Patient Counseling Feedback Forms to improve or maintain a good quality of patient counseling.

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