Characteristics

1) Do you sometimes forget to take your medicine?

• Yes

• No

2) People sometimes miss taking their medicines for reasons other than forgetting. Thinking over the past 2weeks, were there any days when you did not take your medicine?

• Yes

• No

3) Have you ever cut back or stopped taking your medicine without telling your doctor because you felt worse when you took it?

• Yes

• No

4) When you travel or leave home, do you sometimes forget to bring along your medicine?

• Yes

• No