HealthRX.com · Printable question sheet
Ozempic online prescription visit prep sheet
Use this sheet before a telehealth or online visit for Ozempic. Fill it in by hand, bring it to the prescriber or pharmacist, and use it to check whether the prescriber and pharmacy are legitimate before any medicine is ordered.
Prescriber and pharmacy details
Write the details exactly as they appear on the prescriber's and pharmacy's paperwork.
State where prescriber is licensedWrite the state name
Pharmacy addressCheck that it matches the state license
Diagnosis that the prescriber is treatingWrite the diagnosis in your own words
Before the screening visit
Gather these items before you talk with the prescriber.
- Write a list of all medicines and supplements you take now.
- Note any personal history of thyroid cancer or MEN in your notes.
- Write down any family history of thyroid cancer or MEN.
- Note any past serious allergic reaction to semaglutide or its ingredients.
- Write down any history of gallbladder disease or pancreatitis.
- Note whether you have severe gastroparesis or stomach emptying problems.
- Bring your insulin or sulfonylurea details if you use them.
- Check that the seller or pharmacy lists a licensed doctor for questions after delivery.
Questions to ask the prescriber or pharmacist
- Is Ozempic listed as a prescription product, and will you write the prescription?
- Do you screen for personal or family history of thyroid cancer or MEN before prescribing?
- Is the pharmacy you plan to use licensed in my state?
- Which licensed doctor can I contact with questions after the medicine arrives?
- Is the product you plan to send FDA approved, or is it a compounded version?
- What should I do if the package arrives damaged or without instructions for use?
- Will you tell me whom to contact if I have side effects after starting?
Seller and pharmacy verification record
Record each seller or pharmacy you check before ordering.
| Date | Seller or pharmacy | Doctor reachable after delivery | Label or packaging notes |
|---|---|---|---|
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.