If you’re newly diagnosed, have questions about Crohn’s disease, or are not sure whether your condition is under control, talking to your doctor or gastroenterologist can help. It’s important for your doctor to know about how your condition is affecting your daily life.

This Doctor Discussion Guide will help you talk to your doctor about your Crohn’s disease. Just fill in the blanks, then print off your answers and bring them to your doctor’s visit.

Doctor Discussion Guide: Let’s talk about my Crohn’s disease

1.
2.
3.
Yes
No
4.
Diarrhea 0 1 2 3 4 5
Rectal bleeding or blood in the stool 0 1 2 3 4 5
Abdominal cramps or pain 0 1 2 3 4 5
Weight loss or loss of appetite 0 1 2 3 4 5
Fatigue 0 1 2 3 4 5
Symptoms are interfering with my sleep 0 1 2 3 4 5
Symptoms are interfering with my work 0 1 2 3 4 5
Symptoms are interfering with my social life 0 1 2 3 4 5
5.
6.
7.
Yes
No
8.
Biologics (e.g., Humira® [adalimumab], Remicade® [infliximab])
Corticosteroids
5-ASA medications (e.g., Pentasa®, Salofalk®, Salazopyrin®)
9.
Yes
No
10.
Yes
No



Doctor Discussion Guide: Let’s talk about my Crohn’s disease

1. Age:  
2. Gender:  
3. Have you been diagnosed with RA?
I have NOT been diagnosed with Crohn’s disease. 
4. What is the impact of your symptoms? (0 = not experiencing and 5 = severe)
Diarrhea 0 1 2 3 4 5
Rectal bleeding or blood in the stool 0 1 2 3 4 5
Abdominal cramps or pain 0 1 2 3 4 5
Weight loss or loss of appetite 0 1 2 3 4 5
Fatigue 0 1 2 3 4 5
Symptoms are interfering with my sleep 0 1 2 3 4 5
Symptoms are interfering with my work 0 1 2 3 4 5
Symptoms are interfering with my social life 0 1 2 3 4 5
5. How many days of work have you missed in the last month due to your symptoms?
I did not miss work last month due to my symptoms.
6. How many times in the last month have you had to cancel social plans due to your symptoms?
I did not cancel any social plans last month due to my symptoms.
7. Are your symptoms causing you to lose sleep at night?
I am not losing sleep at night due to my symptoms. 
8. What medication(s) are you currently using to treat your Crohn’s disease
I am not currently using a medication to treat my Crohn’s disease.
9. Is your current treatment meeting your expectations?
My current treatment is meeting my expectations.
10. Do you feel your current treatment is easy to incorporate into your life?
My current treatment is easy to fit into my life.

This guide can help you organize your thoughts and questions before seeing your doctor. It can also help get the conversation started in your doctor’s office. You can simply hand the discussion guide to your doctor to get the ball rolling. Plus, the guide can provide your doctor with more information about your symptoms, treatment, and concerns.

Print off your answers and bring them to your doctor’s visit. You and your doctor can work together to find a treatment that’s right for you that will help you take control of your Crohn’s disease.