Templates
14 pages in this section, most recently updated September 4, 2026.
- 01
Weekly dose log: date, dose as prescribed, site and notes
A twelve-week injection log with a column for the dose exactly as your prescriber wrote it, the injection site, the time and a notes field. Prints on one letter page; add a name and start date to pre-fill the dates.
Updated September 4, 2026
- 02
Side-effect diary: symptom, severity 0 to 3, timing after the dose, what helped
A fourteen-day diary for GLP-1 side effects with a plain 0 to 3 severity key, a column for hours since the injection, and a printed list of the symptoms the labels say not to wait on.
Updated September 4, 2026
- 03
Shot-day checklist: before, during and after the injection
A tick list for injection day built from the manufacturers' instructions for use and the FDA's sharps guidance: label match, expiry and beyond-use date, clear solution, storage, site rotation, sharps disposal and the log entry afterwards.
Updated September 4, 2026
- 04
Provider visit question list for GLP-1 follow-ups
Eleven questions to bring to a prescriber follow-up, grouped into medication, monitoring and looking ahead, with answer lines under each. Includes the label points on oral contraceptives and anaesthesia that people forget to raise.
Updated September 4, 2026
- 05
Prior authorization checklist: what payers typically require for a GLP-1
A pre-submission checklist of the documents payers commonly ask for: BMI with dates, comorbidities with codes, weight history, prior weight-management attempts, lifestyle programme evidence and labs, plus what to have ready if the request is denied and what a renewal needs.
Updated September 4, 2026
- 06
Insurance appeal letter template for a GLP-1 coverage denial
A letter skeleton with placeholders for an internal appeal: reference block, the denial reason quoted back, a clinical paragraph, a direct answer to the stated reason, an enclosure list, an expedited request and notice of the external review right. Deadlines from HealthCare.gov printed alongside.
Updated September 4, 2026
- 07
Pharmacy question list for compounded GLP-1 products
Thirteen questions to ask a compounding pharmacy before accepting a vial: state licence and number, 503A or 503B status, prescriber of record, API source, certificate of analysis, concentration and units, excipients, beyond-use date, cold-chain shipping and adverse event reporting.
Updated September 4, 2026
- 08
Travel checklist for GLP-1 pens and vials: storage allowances and TSA rules
A packing list with the unrefrigerated storage allowances from the Wegovy, Ozempic, Zepbound and Mounjaro labels printed on it, plus the TSA rules for medically necessary liquids and gel packs from tsa.gov.
Updated September 4, 2026
- 09
Weekly meal and protein planner with a target line you fill in
A seven-day grid of breakfast, lunch, dinner and snack with a protein-gram cell for each and a daily total. The target line is blank: take it from your clinician or from the protein calculator on the FormBlends Calculators site.
Updated September 4, 2026
- 10
Weight and waist tracker: sixteen weekly rows with change from start
A sixteen-week grid for one weigh-in and one waist measurement a week, with a change-from-start column and a header line to write your method down once so every row is measured the same way.
Updated September 4, 2026
- 11
Hydration and fibre tracker with the reference intakes printed on it
A seven-day tally sheet for fluids and fibre sources, with the National Academies' adequate intakes for total water and fibre printed for context and a bowel-habit column, because constipation is one of the labels' most common adverse reactions.
Updated September 4, 2026
- 12
Maintenance transition checklist: questions for your prescriber, framed by SURMOUNT-4 and STEP 4
Before any change to a GLP-1 plan: the numbers from the two randomised withdrawal trials printed on the sheet, six questions for the prescriber, and a list of what to bring. Nothing on it recommends continuing, reducing or stopping.
Updated September 4, 2026
- 13
Supply and refill tracker: lot, expiry, beyond-use date and doses left
A running inventory for pens and vials: date received, item as labelled, lot number, expiry, the date it first came out of the refrigerator or was opened, doses in it, doses left and a reorder-by date. With an arrival check for cold-chain shipments.
Updated September 4, 2026
- 14
Injection site rotation record: eight weeks across, six sites down
A one-page grid for marking which of six injection sites you used each week, built from the sites the Wegovy and Zepbound labels name and their instruction to rotate with each dose.
Updated September 4, 2026