Clozapine PsychSTART

Clozapine PsychSTART

Making psychiatry easier. Simple access to reliable medications.
🚀PsychWellNow Clozapine Check-In

Why This Form? Answer a few quick questions about your mood, side effects, and labs to start or continue clozapine—potentially without a clinic visit.

⚡Clozapine 101 🔬Clozapine is an antipsychotic often used when other treatments aren’t enough. Frequent blood draws help monitor white blood cell counts to keep you safe.💉

Side Effects?Keep an eye out for fever, chills, or constipation, as these can be serious. If you’ve experienced any of these—or anything else unusual—please let us know. 👀

Urgent?If you have high fever, severe chills, intense constipation, or suicidal thoughts, call 911 or go to the nearest ER. 🚨

By continuing, you confirm you’ve read this and are ready to proceed.

	Yes
Have your thoughts been as clear as usual this week/month?
Have you or your carer noticed hallucinations (voices, smells, seeing images)?
Have you been able to manage your home and/or finances this week/month?
Have you had any thoughts that have worried you this week/month?
Have you attended an emergency department?
Have you been admitted to hospital?
Have you had extra visits to your GP or outpatients?
Have you increased or decreased how much tobacco you smoke?
Do you Vape?
Does your Vape Juice contain nicotine?
Have you started, stopped or changed any medications including pain relief, medication prescribed by a doctor or anything over the counter from the pharmacy?
Have you missed, decreased or increased your dose of any other prescribed medications?

	Yes
Have you had fever or increased sweating?
Have you had a cough or cold recently?
Have you had nausea or vomiting?
Have you felt dizziness when standing up, chest pain or shortness of breath?
Have you noticed any muscle stiffness, jumpy or jerky movements or tremors?
Have you felt more drowsy or sleepy than usual?
Have you had an increase or decrease in saliva or dribbling?
Have your bowel movements changed?
Do you ever have blood in your stools?
Has there been any change in the frequency in which you pass urine?
Have you had any sexual side effects that are bothering you?

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clozapine psychSTARTprescribing and monitoring of clozapine
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