HealthRX.com · Printable question sheet
GHK-Cu and thymosin alpha peptide questions for your prescriber
Use this sheet before talking with a prescriber or pharmacist about a GHK-Cu or thymosin alpha peptide product. It collects product details, questions about FDA status and compounding, and a place to record any reactions you notice.
Your details and current products
Write only what you know. Leave a line blank if unsure.
Name of product or peptideCopy the name exactly as shown on the vial, box or label
Form usedInjectable, topical cream or serum, or other
Where the product came fromClinic, compounding pharmacy, online seller or other
Other medicines and supplementsInclude prescription, over the counter and supplements
Diagnosed conditions and allergiesInclude autoimmune conditions
Pregnancy or breastfeedingWrite yes, no or not sure
Gather before the visit
- Bring the product box, vial or label showing the exact name and maker.
- Bring the name and contact details of the pharmacy or clinic that supplied it.
- Note any written instructions or schedule that came with the product.
- Write down whether the label says it is for use in the United States.
- Check with your prescriber whether the product is FDA-approved for your use.
- Bring a complete list of all other medicines and supplements you take.
- Note the date you started the product and any date you stopped it.
Questions for your prescriber or pharmacist
- Is this product FDA-approved for any use in the United States?
- Is it a compounded product, and who checked its quality and purity?
- Does the schedule on this label apply to use in the United States?
- Could any of my other medicines or supplements interact with it?
- Which of my medical conditions could make this a concern for me?
- What reactions should I report to you, and how quickly should I report them?
- Would a lab test or monitoring plan be useful in my situation?
- What would you need to see before deciding whether to continue?
Reactions and observations
Write what you noticed, even if it seems minor. Bring this page to your visit.
| Date | Product used | What I noticed | Told provider |
|---|---|---|---|