HealthRX.com · Printable training log
Wegovy caregiver injection training and weekly record
Use this sheet with a caregiver who will give Wegovy injections at home. Record the pen presentation and training, check each weekly injection, and bring it to the prescriber or pharmacist to ask about the questions listed.
Patient and caregiver details
Write names as they appear on the prescription.
Patient nameFull name and date of birth
Caregiver name(s)Everyone who may give the injection
Prescriber name
Pharmacy name and phone
Injection day each weekThe same day every week
Pen presentation and training
Presentation receivedSingle-dose pen, syringe or FlexTouch pen
Date training was completed
Name of person who trained us
Date to retrain if presentation changes
Before the first injection
- Confirm which presentation the patient will receive and write it above.
- Bring the Instructions for Use for that presentation to the training.
- Check that every caregiver who may inject has been trained on that pen.
- Ask whether the patient may self-inject, and write the answer down.
- Note whether the patient has a visual impairment that affects self-injection.
- Confirm the FlexTouch pen will never be shared between patients.
- Bring a list of all other medicines, including insulin or sulfonylureas.
- Check with the pharmacist how to store the pen and where to dispose of needles.
Weekly injection record
Write one line each time an injection is given or missed.
| Date | Site used | Liquid clear | Given by | Notes |
|---|---|---|---|---|
Questions for the prescriber or pharmacist
- Which pen presentation is right for the patient, and who will retrain us if it changes?
- What should we do if a weekly dose is missed, and how many days late is too late?
- Which fluid loss or dehydration signs should we report to you straight away?
- Should we check blood sugar more often if other diabetes medicines are taken?
- Do any other medicines need closer monitoring, given how semaglutide affects absorption?
- What symptoms of pancreatitis or thyroid problems should we report urgently?
- Who should we tell before any planned surgery or procedure that needs anesthesia?
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.