It is important to talk to your healthcare team about any side-effects or symptoms that you are experiencing. This tool will help you to do that.
You’ll be asked a series of questions about possible side-effects or symptoms. If you are having a problem with a side-effect or symptom, you’ll then be asked for a few more details – how often it occurs, how severe it is and whether it interferes with your usual activities. This information will help your doctor understand the impact the side-effect or symptom is having on your day-to-day life.
You’ll then get a summary of your answers to use as a checklist to discuss with your doctor and healthcare team.
You can print this checklist, send it as an email or save it as a PDF. To start, please click the button below.
How the Side-effects checker works 1. Answer a series of short questions You will be asked a series of questions about side-effects and symptoms. You can answer all the questions or you can skip any you don’t want to answer.
There are fewer than 25 questions and it should take about five minutes to complete. You won't be asked for your name.
2. Print, email or save a PDF of your personalised report Once you have finished answering the questions, the tool produces a personalised report for you, which you can print, save as a PDF or send as an email. We won’t store your email address.
3. Talk to your doctor or healthcare team You can take the report to your next clinic appointment, so your doctor or another member of your healthcare team can see which side-effects or symptoms you are experiencing. They can help you find a way to manage the problem.
Have you felt tired or lacking in energy? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you had headaches? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you had nausea or vomiting? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you had pain in the abdomen (belly area)? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you had diarrhoea (loose or watery stools)? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you had increased flatulence (passing of wind)? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you had a skin rash? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you had yellow skin and/or yellow eyes? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you had insomnia (difficulties falling asleep or staying asleep, or waking up too early)? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you suffered from vivid dreams or nightmares? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you felt sad, down or depressed? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you felt nervous or anxious? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you had mood swings? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you had problems with memory or concentration? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you felt dizzy? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you had any problems with weight loss or weight gain? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you had numbness, tingling or pain in your hands or feet? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you had aching muscles? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you had aching joints (such as elbows, knees, shoulders)? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you experienced a loss of appetite or a change in the taste of food? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you had heartburn or bloating? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you had any side-effects or symptoms affecting your mouth or throat? Please answer in relation to the last four weeks. Please leave out any cases for which you know the cause (for example, an illness).
Yes
Over the last four weeks, how often have you had this side-effect or symptom? Rarely
Occasionally
Frequently
Almost constantly
How severe has this side-effect or symptom been? Mild
Moderate
Severe
Very severe
How much has it interfered with your usual or daily activities? Not at all
Somewhat
Quite a bit
Very much
No
Have you had any other side-effects or symptoms that you haven’t already told us about? If yes, please give details in the boxes below
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