To prepare for your next doctor’s visit, describe your symptoms and current treatment experience using the questions below. When complete, you’ll generate a personalized readout designed to help you talk with your doctor about your treatment goals.
Feel free to answer the questions in any order you like. You’ll be able to move forward and back throughout, and change your answers if necessary.
You’ll be able to download your answers or send them to your email, so you can have them in hand for your next doctor appointment.
Don’t have time to fill out the form now? Click below to get a copy you can fill in and complete when you have time.
Download a Customizable Treatment Conversation PDF
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Step 1: Severity, Area, and Intensity
1. What symptoms are you currently experiencing? Select all that apply.
2. Where are you currently experiencing symptoms?
Click on the parts of the body where you have symptoms. Check as many areas as necessary.
One way doctors determine plaque psoriasis severity is to evaluate the percentage of the body that's covered by plaques.
One way doctors determine plaque psoriasis severity is to evaluate the percentage of the body that's covered by plaques. Based on your answer plaque may cover more than 10% of your body.
Mild Plaque Psoriasis*
Plaques on less than 3% of the body.
Moderate Plaque Psoriasis*
Plaques on 3-10% of the body.
Severe Plaque Psoriasis
Plaques on more than 10% of the body.
There are also other factors that are taken into consideration for severity. Be sure to tell your doctor where your plaques appear or if they are especially thick, red, scaly, or itchy to ensure you receive an accurate diagnosis.
It’s important to also talk to your doctor about any psoriatic arthritis symptoms you may be experiencing, such as joint pain, stiffness, and swelling.
*A treatment like SKYRIZI is not meant to treat cases of mild psoriasis. In clinical trials, patients had at least 10% of their body affected by psoriasis.
3. What percentage of your body is affected by plaque psoriasis?
You can use your hand to figure it out. Using one hand to represent 1% of body surface, measure how much of your body is covered by psoriasis.
If you are experiencing joint symptoms, how many swollen and/or tender joints do you have?
4. In the past year, has there been a change in the severity of your symptoms and where they appear?
If you answered yes and are experiencing any new or worsening symptoms, it’s important to describe those details to your doctor at your next appointment.
Your doctor may reevaluate your treatment plan depending on the symptoms you may be experiencing.
Step 2: Treatment Experience
1. How are you currently treating your symptoms? Check all that apply.
Could SKYRIZI be right for you? It’s important to discuss treatment options and expectations with your doctor, and work together to recognize when it might be time to consider different treatment options.
2. What are you looking for when discussing a different treatment with your doctor? Check all that apply.
SKYRIZI can help you achieve clearer skin with 4 doses a year, after 2 starter doses. In Ps clinical trials, 3 out of 4 people achieved 90% clearer skin at 4 months, with just 2 doses. Ask your doctor if SKYRIZI could work for you.
In PsA clinical trials, a majority of people felt significant relief of their PsA symptoms, including joint pain, tenderness, stiffness, and swelling at 24 weeks.
SKYRIZI can help you achieve clearer skin with 4 doses a year, after 2 starter doses.In Ps clinical trials, 3 out of 4 people achieved 90% clearer skin at 4 months, with just 2 doses. Ask your doctor if SKYRIZI could work for you.
Step 3: Daily Management
Why does the amount of time you're spending matter? Your treatment may need to be reevaluated if you're spending more time than you want managing your disease. If you're devoting a lot of time to symptom management, be sure to share those details with your doctor.
2. How have these symptoms impacted your life? Check all that apply.
Plaque psoriasis and/or psoriatic arthritis affect everyone differently. That’s why it’s important to talk with your doctor about the full impact all symptoms have on you.
3. How often are you experiencing swollen or stiff limbs and joint pain symptoms?
Step 4: Setting New Goals
Treatment goals help keep you focused during your appointment with your doctor.
Please answer the questions below.
1. How long have you been using your current medication(s) to treat your symptoms?
2. How satisfied are you with your current treatment?
3. When would you like to see your desired results?
Let's get your conversation ready.
Fill in your email address to receive all your answers in your inbox, or click the link below to download a PDF version. You can take these responses to your next doctor appointment to help focus the conversation on what matters most to you.
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