GLP-1 Health Companion & Screener

💉

GLP-1 Health Companion

Your Personal Guide to Ozempic, Wegovy, Mounjaro & Zepbound

Patient Companion

Welcome to Your GLP-1 Journey!

Stay on track with your weekly injections, prevent dehydration, and easily monitor your milestone weight changes.

💧 Daily Hydration

Target: 64 oz to protect kidneys & stop constipation.

🥗 Lean Protein Habit

Target: 70g+ to protect muscle mass.

💉 Next Scheduled Shot

Rotate injection locations every week.

Current Dose

2.5 mg

Due Sunday

Last injected site: Right Lower Stomach

⚖️ Weight Loss Milestones

% of Total Body Weight Lost

-24.0 lbs 11.3% Lost

Starting: 212 lbs • Current: 188 lbs

Goal: 155 lbs (42% completed)

🛡️ Safety Status

Pre-treatment screening result

✓ ELIGIBLE FOR THERAPY

No absolute thyroid or pregnancy contraindications flagged. Maintain close hydration and review side effects weekly.

📋 GLP-1 Pre-Treatment Safety Screener

Answer truthfully before starting Semaglutide (Ozempic/Wegovy) or Tirzepatide (Mounjaro/Zepbound).

CLEAR TO PROCEED

💡 Why do we ask these questions? GLP-1 medications slow down how quickly food leaves your stomach and affect hormone pathways. Certain family medical histories require extra precautions.

1. Absolute Safety Disqualifiers (FDA Black Box)

Medullary Thyroid Carcinoma (MTC)

Do you or any blood relative have a history of Medullary Thyroid Carcinoma?

Multiple Endocrine Neoplasia Type 2 (MEN 2)

Have you been diagnosed with Multiple Endocrine Neoplasia syndrome type 2?

Pregnancy or Nursing

Are you currently pregnant, nursing, or planning pregnancy within the next 2 months?

2. Conditions Requiring Doctor Review

History of Pancreatitis

Have you ever had acute or chronic inflammation of the pancreas?

Severe Digestive / Stomach Motility Issues

Do you have severe gastroparesis (delayed stomach emptying) or active IBD?

Taking Insulin or Sulfonylureas (Glipizide/Glimepiride)

Combining these with GLP-1 can cause low blood sugar; dose reduction is often required.

Oral Birth Control Pills

Tirzepatide delays pill absorption. A backup non-oral method is needed for 4 weeks.

Upcoming Surgery / Anesthesia

GLP-1 must be held for 1 week prior to elective anesthesia to avoid stomach aspiration.

💉 Weekly Injection & Anatomical Site Logger

Rotate injection sites weekly to prevent lumps and maximize comfortable absorption.

Standard Escalation Schedule (Tirzepatide Protocol)

Weeks 1-4

2.5 mg

Active Tier

Weeks 5-8

5.0 mg

Step Up

Weeks 9-12

7.5 mg

Intermediate

Weeks 13-16

10.0 mg

Maintenance

Where did you inject today? (Tap to select)

🎯

Right Lower Stomach

2 inches to right of navel

🎯

Left Lower Stomach

2 inches to left of navel

🦵

Front Right Thigh

Middle top of thigh

🦵

Front Left Thigh

Middle top of thigh

💪

Back of Right Arm

Outer tricep area

Injection Date

Dose Taken

Selected Injection Site

Notes (Any redness or sting?)

Recent Injections

Date	Dose	Site	Notes
2025-03-23	2.5 mg	Right Lower Stomach	No irritation. Good appetite regulation.
2025-03-16	2.5 mg	Front Left Thigh	Rotated to thigh smoothly.

⚖️ Weight Journey & Progress

Visualizing your progress towards your health goals.

Date

Current Weight (lbs)

📝 Daily Feelings & Stomach Check-In

Keep track of nausea, reflux, or bowel habits so your doctor can help you manage them.

⚠️ When to Call the Clinic Immediately: Contact your provider right away if you experience severe persistent stomach pain that radiates to your back (pancreatitis risk) or cannot keep liquids down.

Nausea Level (0 to 5)

Constipation Level (0 to 5)

Personal Notes

💡 Tips to Prevent Nausea & Stomach Upset

Eat smaller meals and stop at the very first sign of fullness.
Avoid greasy, fried, or high-sugar foods which slow the stomach down even more.
Do not lie down for at least 2 hours after finishing a meal.
Sip ginger tea or ice water throughout the day.

📄 Ready for Your Next Appointment

Share your doses, weight changes, and symptoms directly with your healthcare provider.

✓ Summary copied! You can paste it into a message to your doctor.

GLP-1 Patient Progress Report

Clinical Visit Summary Note

Date: Today

Medication: Tirzepatide (Mounjaro/Zepbound)

START WEIGHT 212 lbs

CURRENT WEIGHT 188 lbs

TOTAL LOST -24.0 lbs (11.3%)

SAFETY STATUS CLEARED

Active Medication Protocol

Current Dose: 2.5 mg Subcutaneous Weekly • Injection Site: Right Lower Stomach. Compliance: 100% on schedule.

Side Effects & Tolerability

Patient reports good tolerability. Mild transient post-meal fullness noted. No severe nausea, vomiting, or signs of acute abdomen reported.

Patient Signature: _________________________

Clinician Signature: _________________________