HealthRX.com · Printable question sheet
Epitalon prescription and access questions sheet
Use this sheet before asking a prescriber, pharmacist or insurer whether epitalon can be obtained with a prescription. Write down the product details, gather the papers you have, bring the questions, and log each contact.
Product and contact details
Write what the seller or pharmacy actually shows you.
Product name as written on the offerCopy the wording exactly as shown
Form offered (vial, capsule or oral spray)Circle or write the form
Seller nameName only, not the web address
Amount stated per vial or containerCopy the stated amount and unit
Gather before the visit
Bring copies, not originals, where possible.
- Write down the product name and every label line you can read.
- Bring any prescription paper or message you have received.
- List every other medicine and supplement you currently take.
- Bring the seller's written claims or promotion for the product.
- Confirm whether the pharmacy you plan to use compounds peptides.
- Check whether a prescriber has already written this exact request for you.
- Note the name of the insurer and the plan type you hold.
Questions to ask at the visit
- Is epitalon on FDA's list of bulk substances that pharmacies may compound with?
- Does the draft HHS enforcement-discretion policy apply to my situation?
- Will the pharmacy give me the manufacturer's certificate of analysis?
- Will the label read as the draft policy describes for compounded products?
- What evidence do you rely on before prescribing a product like this?
- Would my insurer cover a product that is not FDA approved?
- Who is responsible if a product I receive does not match its label?
Contact and response log
Record each call, visit or message and what was said.
| Date | Person contacted | Answer given | Follow-up needed |
|---|---|---|---|
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.