GLP-1 Appointment Printable: A One-Page Snapshot to Fill In

This GLP-1 appointment printable is a one-page snapshot you fill in before a follow-up: your medication and dose dates, how things are going, symptoms with dates, other medicines, practical hurdles like cost or refills, and the three questions you most want answered. Copy it into a document or notes app, fill it in, and bring it or send it ahead.

It is a planning tool, not a medical form. Leave blank anything that does not apply, and never fill a gap with a guess.

Why one page?

Because appointments are short and memory is unreliable. MedlinePlus advises writing down your questions and concerns, every medicine and supplement you take, and the details of your symptoms (what they feel like, when they happen, how long you have had them) before you go. A single page makes that list easy to hand over and easy to read.

The page also keeps you from leaving with the classic regret: "I forgot to ask about the thing I was most worried about."

The GLP-1 Appointment Snapshot (copy this)

Appointment date: ____________ With: ____________________

1. What matters most to me today

The one thing I most want to leave knowing or deciding:

---

2. My top three questions

1. ---

2. ---

3. ---

3. My GLP-1 medication

Item	My answer
Medicine name (brand or generic)
Form (weekly pen, vial, daily pill, other)
Current prescribed strength
Usual dose day and time
Date started this strength
Last dose taken (date)
Missed, late or doubled doses since last visit (dates)
Where I get it (pharmacy, mail order, other)

4. How it is going

Area	Since my last visit
Weight trend (start, now, direction)
Appetite and fullness
Energy
Sleep
Mood
Anything better than expected

5. Symptoms I want to discuss

Symptom	Started (date)	How often	How bad (mild / moderate / severe)	Linked to dose days?	What helped

6. Other medicines and changes

• Prescription medicines: ________________________________
• Over-the-counter medicines: ____________________________
• Vitamins, supplements, herbal products: ____________________
• New diagnosis, illness or hospital visit: _____________________
• Planned surgery, procedure, colonoscopy or dental work: ________
• Pregnancy plans, birth control changes, or breastfeeding: ________

7. Practical hurdles

• Cost or coverage changed
• Trouble getting refills or a shortage at my pharmacy
• Hard to fit the dose into my schedule (shifts, travel)
• Unsure about injection technique or storage
• Something else: ______________________

8. Estimates and gaps (keep it honest)

• Numbers that are estimates (for example, food from photo scans, app-estimated medication curves): ______________
• Days or weeks I did not track: ______________

9. Before I leave

• I know what to do next with my dose (stay, change, or wait)
• I know what symptoms mean I should call before the next visit
• I know when my next appointment or check-in is
• I know how to reach the office (portal, phone)
• I wrote down anything I need to track before next time

How to fill it in without spending all evening

Start with sections 1 and 2. If you only have five minutes, those two boxes make the visit better on their own.

Pull dates from your log. Paper calendar, notes app or tracker, whichever you use. In GLPily, the shot and pill log, weight, symptoms and journal are all dated, and you can ask the Pily AI helper something like "what dates did I log nausea this month?" to fill section 5 faster.

Write "dates," not "a while ago." "Nausea most days from Sept 2 to Sept 9" is far more useful than "nausea for a bit."

List everything in section 6. That includes over-the-counter products and supplements. Some details matter for GLP-1 medicines specifically: an upcoming procedure (see Taking a GLP-1 Before Surgery) or birth control pills on tirzepatide (see Does Tirzepatide Affect Birth Control Pills?).

Be honest in section 8. Your clinician can work with gaps. They cannot work with guesses dressed up as facts.

How to use the snapshot during the visit

• Hand it over at the start, or upload it through the patient portal ahead of time if your clinic accepts that. Then say your section 1 out loud.
• Ask your top question first, not last. Time runs out from the end.
• Bring a support person if you like. MedlinePlus suggests a friend or family member can help you remember what was said.
• Take notes in section 9 as you go, and ask for written instructions if that helps.
• Bring the article, not the rumor. If you read something online you want to ask about, MedlinePlus suggests printing it and bringing it along, so your clinician can see exactly what it claims.
• Ask what to track next time. Different questions need different data; your clinician may only want weight and one symptom.

Want to send a fuller summary of your tracking data instead? Sharing GLP-1 Tracking Data With Your Doctor shows what makes a report useful. For a deeper review a few months in, use the three-month check-in topics.

Do not wait for the appointment if…

This page is for planned visits. Do not save urgent problems for it. MedlinePlus advises contacting your provider if you have side effects or new or worsening symptoms. For severe symptoms, such as severe stomach pain that will not go away, signs of a serious allergic reaction, or being unable to keep fluids down, call your prescriber, seek urgent care or call 911. If you think you took too much medicine, call Poison Control at 1-800-222-1222.

A separate, always-current medication list for urgent care is a good idea too: Build a Medication List for Urgent Care.

Common questions

What should I bring to a GLP-1 follow-up appointment?

Your medication details and dose dates, a short summary of how things are going, symptoms with dates, a list of all other medicines and supplements, and your top three questions. This one-page snapshot covers all of it.

What questions should I ask at a GLP-1 follow-up?

Start with whatever matters most to you today. Common ones: whether to stay at the current dose, which side effects are worth reporting, what to do before a procedure, and what to track before the next visit.

Can I fill this out on my phone instead of printing it?

Yes. Copy it into a notes app or document, fill it in, and show it at the visit or send it through your clinic's portal if they accept that.

Is this form a replacement for my clinic's paperwork?

No. It is your own planning sheet. Your clinic may have its own forms, and they come first.