This tool will help you to create a document that you can bring to your doctor's office to help at your visit.

Before visiting your doctor, fill out this guide, print it, and bring it to the visit.

How to use this tool:

  • Answer the questions below and fill out the appropriate areas.
  • Print your responses.
  • Bring your printed response page to your doctor's appointment.

My symptoms

Select all that apply and enter any additional symptoms in the spaces provided:

vaginal itching, burning, redness, or swelling
vaginal pain or discomfort during sex
pain or a burning feeling during urination
more vaginal discharge than usual
vaginal discharge that smells fishy
vaginal discharge that looks like cottage cheese
frothy-looking vaginal discharge
other symptoms

Date my symptoms started


Other information my doctor needs to know

There are a number of pieces of information that will help your doctor give you the most appropriate treatment. Check off or fill in the boxes on the ones that apply to you:

I have never had a yeast infection before.
I have diabetes.
I use feminine sprays or douches.
I have a high level of stress.
I might have a sexually transmitted infection or STD.
It has been less than 2 months since my last yeast infection.
I have a fever, pelvic pain or fishy-smelling or discoloured (yellow/grey) discharge.
I am under the age of 12.
I have sex frequently.
I exercise frequently.
I have had 4 or more yeast infections over the last year.
I may have a weakened immune system (cancer, AIDS, other conditions).
I am pregnant or breast-feeding.

My medications (include any birth control pills, herbal medications or supplements, and over-the-counter medications):



When you press "Submit," a pop-up window will appear with a printable summary to take to your doctor.

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