HealthRX.com · Printable question sheet
BPC peptide compounding pharmacy visit sheet
Use this sheet before and during a visit with a prescriber or pharmacist about a compounded BPC peptide product. Fill it in by hand, bring it along, and keep a copy at home to track the product's source and paperwork.
Pharmacy and prescriber details
Write what the label, prescription or pharmacy staff tell you. Leave blank if unknown.
Pharmacy name and addressAs printed on the label
Pharmacy registration typeState-licensed pharmacy, outsourcing facility or other, as stated
Prescriber nameLicensed physician or other prescriber
Ingredient name on the labelWrite exactly what is printed, such as acetate or free base
Route listed on the prescriptionSubcutaneous, intramuscular, oral, topical or other
Pharmacist contact phoneNumber on the pharmacy label or website
Documents and details to bring
Gather these before the visit.
- Bring the prescription or written order as received from the prescriber.
- Bring the product label or a photo of it, including the compounded drug statement.
- Note the single active ingredient named on the label.
- Ask the pharmacy for the bulk substance source and certificate of analysis details.
- Bring any syringe packaging details, including whether the syringe is co-packaged.
- Write down any reactions you have noticed and when they started.
- Bring a list of other medicines and supplements you currently use.
- Confirm who to contact if a reaction or product quality problem occurs.
Questions for the pharmacist or prescriber
- Is this product made by a state-licensed pharmacy, a federal facility or a licensed physician?
- Does the product contain BPC peptide acetate, and is it a single active ingredient?
- Which route is on my prescription, and is it one of the forms listed in the draft policy?
- Where does the bulk substance come from, and is that manufacturer FDA-registered?
- Can you show me the certificate of analysis for this batch?
- Will this product carry the required compounded drug label?
- If an adverse event happens, who reports it to FDA MedWatch?
- What documentation exists for the route, given that FDA found limited human safety data?
Pharmacy and product source record
Record each fill or change so the source stays traceable.
| Date | Pharmacy | Route on label | Batch or lot | Notes |
|---|---|---|---|---|