Medical Expense Worksheet

Please summarize your annual medical and dental expenses by category on this form. We are emailing this as a PDF document

if you prefer we can send this schedule as an excel at your request.

Please note that for 2013 and beyond in order to claim any medical expenses as deduction they must exceed 10% of your

adjusted gross income.

Dependent

Children (if

You

Your Spouse

any)

Total

Doctor co pays

Payments to your Dentist

Payments to your Chiropractor

Payments to your Therapist

Payments to your other medical providers

Payments you made for the purchase of glasses

Payments you made for the purchase of health insurance for your family

Payments for the purchase of long term care insurance

Payments you made for the purchase of prescriptions

Payments you made for the purchase of other medical related items

Miles driven for medical purposes

0 votes

Parent category: Medical