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Tool

Bring a summary, not a scrollback.

A one-page template to organize the last few weeks before an appointment: weight trend, doses, symptoms, and the questions you keep forgetting. Print it or fill it in on your phone. Nothing is uploaded.

PrintableOne pageNothing uploadedNot medical advice

The conversation starts before the visit.

Fill in what matters, leave out what you do not want to share, and bring the page with you. The app can generate a fuller Care Brief from your recorded data.

Not a medical record. This template does not diagnose, treat, prescribe, or tell you to change a dose. It does not save or send your entries. Share only what you choose.
1. The basics
2. Weight trend
3. GLP-1 doses
4. Symptoms

Record what happened, when, and how severe. Do not guess at a cause.

5. Nutrition and activity
6. Questions for my provider
7. Before you share

The app can generate the full summary.

If you record doses, symptoms, injection sites, and notes in the app, the Care Brief can turn a date range into a PDF, CSV, or printout — with section toggles and anonymization options.

Explore the GLP-1 trackerHow sharing works

Scope and sources

This is a preparation template, not a clinical protocol. The categories are based on public patient-communication guidance and common visit structure. It does not provide medical advice.

Last updated: November 9, 2026. This page has not been reviewed by a clinician for individual care.

Care brief questions.

Is this the same as the app’s Care Brief?
No. This is a blank printable template you fill in yourself. The app’s Care Brief is generated from your recorded data and can be exported as a PDF, CSV, or printout with date ranges and anonymization options.
Does this page save or send my answers?
No. The fields run in your browser. Nothing is sent to a server, and this page does not store your entries. If you print the page, your browser handles the printout.
What should I include?
Include what you are comfortable sharing and what will help the conversation: weight trend, doses, symptoms, questions, and context. You do not need to include identifying information. Share only what you choose.
Can I use this for a telehealth visit?
Yes. Keep the completed template in front of you during the visit. You can also read from it or share your screen if you choose.
Is this a medical record?
No. It is a preparation tool, not a medical record. It does not replace your provider’s notes, your medication record, or the product label.
Does this tell me what dose to take or how to treat a symptom?
No. It does not provide dosing, treatment, or stopping advice. Those decisions belong to you and your prescriber.

Keep exploring

GLP-1 appointment checklist

A fuller first-visit and follow-up checklist.

GLP-1 tracker

Doses, symptoms, injection sites, and a generated Care Brief.

Injection sites

Label-based sites and a rotation record.

From template to record

A better summary starts with better records.

Track doses, symptoms, injection sites, and notes — then generate a Care Brief when you need it.

Get it onGoogle PlayOpen the appointment checklist
  • 1M+ installs since 2013
  • Current version 4.2
  • No account required
  • Free on Android
Free on AndroidGet it onGoogle Play