BENZOHELP PRINTABLE

Appointment guide

This sheet does not provide a tapering schedule. Use it to organize information for a qualified healthcare professional. Do not abruptly stop or change medication based on this document.

Medication information

Medication name (generic and brand, if known)

Current dose and tablet/liquid strength

Times taken each day

Approximate start date

Prescribing clinician

Other prescriptions, over-the-counter medicines, supplements, alcohol, or other substances

My experience

Reason the medication was originally prescribed

Current benefits or concerns

Previous dose changes, missed doses, or discontinuation attempts—and what happened

Symptoms and effects on sleep, work, relationships, driving, or daily function

Questions and plan

My three most important questions

Follow-up date, contact method, and what to do if symptoms worsen

Emergency: Seizures, severe confusion, hallucinations, loss of consciousness, trouble breathing, or thoughts of suicide or harming someone require immediate help. In the U.S., call 911; call or text 988 for suicide or crisis support.

BenzoHelp.org · Educational only · Version reviewed September 2026