Methylene blue
Clinician conversation planner
Prepare your question and record the professional review. This worksheet does not determine suitability or authorize treatment. Do not change prescribed medicines on your own.
1. My main question and goal
What problem do I want help with? When did it begin? What would meaningful improvement look like?
2. Exact product and recommendation
Product / manufacturer / concentration / intended use / lot. Attach label photos. Proposed route and who recommended it:
Study title or link and the specific claim I want reviewed:
3. Current medicines and supplements
Include prescription, nonprescription, occasional products, and recent changes. Attach a longer list if needed.
| Product / active ingredients | Current amount and timing | Recent change / last occasional use |
|---|---|---|
4. History and questions for professional review
Diagnoses, allergies, previous reactions, pregnancy / breastfeeding, relevant tests or unknowns. Ask which information matters.
5. Evidence and alternatives discussed
Does the study match my goal, population, product, and route? What remains uncertain? What other options address my goal?
6. Agreed next step and follow-up
Decision / further assessment / person responsible / follow-up date:
How will outcomes be assessed? Who do I contact with questions or new symptoms?