HealthRX.com · Printable question sheet
BPC peptide compounding status questions for prescribers
Use before a visit with a prescriber or pharmacist about a BPC peptide product. Write down the product details, the paperwork you have, your questions, and any symptoms you notice so you can compare them with what the clinic or pharmacy tells you.
Product and visit details
Write what the label or pharmacy paperwork says. Leave blank anything you do not have.
Name of prescriber or pharmacistFull name and clinic or pharmacy
Name on the product labelCopy the wording exactly, including BPC peptide and acetate
Form of the productFor example injection, oral, or topical
Compounding pharmacy namePharmacy that filled the prescription
Bulk substance sourceManufacturer named on the paperwork, if shown
Reason for the prescriptionWrite the condition or goal in your own words
Bring to the visit
Gather these before you go.
- Bring the product label or a photo of it showing the 'not for resale' wording.
- Bring the prescription paperwork that names you as the patient.
- Bring any certificate of analysis the pharmacy gave you for the bulk substance.
- List every other medicine, supplement and peptide you currently use.
- Note whether the product is an acetate salt or a free base, if the label says.
- Bring the syringe or device packed with the product, if one came with it.
- Bring your symptom log from the table on this sheet.
Questions to ask
- Is this BPC peptide product made from the acetate salt?
- Is the bulk substance from an FDA-registered manufacturer?
- Can you show me the certificate of analysis for this batch?
- Does the label say this is a compounded drug product, not for resale?
- Is the syringe packed with my product cleared by FDA?
- Is this product on any federal list that pharmacies may compound from?
- What should I do and whom should I call if I notice a side effect?
- Will you report any serious problem to FDA MedWatch?
Symptoms and changes to report
Record each time you notice something, even if you are unsure it is linked to the product.
| Date | Product used | What I noticed | Told my clinic? |
|---|---|---|---|