Clinical Form Templates
for Every Program
Free patient intake forms, informed consent templates, and screening questionnaires for GLP-1, TRT, peptide therapy, sexual health, wellness, and hair loss programs. Built for practices, med spas, and telehealth operators launching cash-pay services.
43
Form Templates
8
Program Types
100%
Free to Use
118
Regulatory Citations
GLP-1 / Weight Loss
Intake, consent, and screening forms for semaglutide, tirzepatide, and medical weight management programs.
GLP-1 Patient Intake Form
Download a free GLP-1 patient intake form template for your clinic. Covers medical history, contraindications, BMI screening, and medication reconciliation. Customizable for semaglutide and tirzepatide programs.
Semaglutide Consent Form
Free semaglutide informed consent form template for medical practices. Covers risks, benefits, side effects, contraindications, and compounded medication disclosures. Download and customize.
GLP-1 Refill Form
Free GLP-1 refill and follow-up form template for semaglutide and tirzepatide programs. Captures current weight, injection history, new medications, and any health changes since last visit.
Retatrutide Patient Intake Form
Download a free Retatrutide patient intake form template for your clinic. Covers contraindications, weight-related conditions, symptoms, and prior GLP-1 history for this triple-agonist weight loss therapy.
Testosterone (TRT)
Intake and assessment forms for testosterone replacement therapy programs.
TRT Patient Intake Form
Free testosterone replacement therapy (TRT) patient intake form template. Covers symptom assessment, lab requirements, contraindication screening, and medical history. Download and customize for your practice.
Enclomiphene Intake Form
Free Enclomiphene citrate intake form template for TRT and men's health clinics. Covers testosterone deficiency indications, prior TRT history, visual disturbances, and hormonal therapy screening.
Testosterone Cypionate Intake Form
Free Testosterone Cypionate TRT intake form template for men's health and hormone clinics. Covers hypogonadism indications, prostate and cardiovascular contraindications, and identity verification.
Peptide Therapy
Consent, screening, and intake forms for peptide therapy protocols.
Peptide Therapy Consent Form
Free peptide therapy informed consent form template. Covers BPC-157, CJC-1295, PT-141, and other therapeutic peptides. Includes off-label use disclosures, compounding pharmacy requirements, and risk acknowledgments.
BPC-157 Peptide Screening Form
Free BPC-157 peptide screening form template for compounding pharmacies and integrative clinics. Covers tissue repair indications, contraindications, and off-label prescribing requirements.
CJC-1295 / Ipamorelin Peptide Screening Form
Free CJC-1295 and Ipamorelin peptide screening form for compounding clinics. Covers growth hormone secretagogue indications, contraindications, and patient eligibility criteria.
DSIP Peptide Screening Form
Free Delta Sleep-Inducing Peptide (DSIP) screening form template for compounding clinics. Covers sleep disorder indications, contraindications, and patient eligibility criteria.
DSIP / BPC-157 / CJC Combination Screening Form
Free combination peptide screening form covering DSIP, BPC-157, and CJC for compounding clinics. Screens for sleep, recovery, and growth hormone indications with combined contraindication review.
Epithalon Peptide Screening Form
Free Epithalon peptide screening form template for integrative and anti-aging clinics. Covers telomere and longevity indications, sleep support, and contraindications for off-label prescribing.
GHK-Cu / Epithalon Peptide Screening Form
Free GHK-Cu and Epithalon combination peptide screening form for compounding clinics. Covers tissue repair, anti-aging, sleep, and longevity indications with contraindication review.
IGF-LR3 Peptide Screening Form
Free IGF-LR3 insulin-like growth factor peptide screening form for compounding clinics. Covers body composition and recovery indications, metabolic contraindications, and patient eligibility criteria.
Kisspeptin Peptide Screening Form
Free Kisspeptin peptide screening form for reproductive health and hormone clinics. Covers fertility, libido, and hormonal imbalance indications with contraindications for off-label prescribing.
LL-37 Peptide Screening Form
Free LL-37 antimicrobial peptide screening form for compounding clinics. Covers immune support and wound healing indications, autoimmune contraindications, and patient eligibility criteria.
Melanotan II Peptide Screening Form
Free Melanotan II peptide screening form for compounding clinics. Covers skin pigmentation indications, dermatologic contraindications, and cardiovascular screening for off-label prescribing.
MOTS-c Peptide Screening Form
Free MOTS-c mitochondrial peptide screening form for metabolic health and longevity clinics. Covers metabolic and energy indications, insulin resistance screening, and contraindications.
Pinealon / PE22-28 / Selank Peptide Screening Form
Free Pinealon, PE22-28, and Selank combination cognitive and anxiolytic peptide screening form. Covers anxiety, cognitive, and sleep indications with neuropsychiatric contraindications.
Semax / Selank Peptide Screening Form
Free Semax and Selank cognitive and anxiolytic peptide screening form for compounding clinics. Covers nootropic and anxiety indications, neuropsychiatric contraindications, and patient eligibility.
Tesamorelin Peptide Screening Form
Free Tesamorelin GHRH peptide screening form for metabolic health and body composition clinics. Covers visceral fat and GH deficiency indications with diabetes and cancer contraindications.
Thymosin Alpha-1 Peptide Screening Form
Free Thymosin Alpha-1 immune peptide screening form for integrative and functional medicine clinics. Covers immune support indications, autoimmune contraindications, and patient eligibility.
SS-31 Peptide Screening Form
Free SS-31 (Elamipretide) mitochondrial peptide screening form for longevity and metabolic health clinics. Covers cellular energy, cardiovascular, and cognitive indications with contraindications.
Sermorelin Intake Form
Free Sermorelin peptide intake form template for anti-aging and wellness clinics. Covers growth hormone deficiency indications, cancer and steroid contraindications, and patient eligibility.
Oral GHK-Cu Intake Form
Free oral GHK-Cu (copper tripeptide) intake form template for compounding and wellness clinics. Covers tissue repair and skin aging indications with cancer and organ disease contraindications.
Hormone Replacement (HRT)
Intake forms for menopausal hormone therapy and BHRT programs.
Sexual Health
Intake forms for sexual health programs including PT-141, ED treatments, and oxytocin protocols.
PT-141 (Bremelanotide) Intake Form
Free PT-141 (Bremelanotide) sexual health intake form template. Covers libido and sexual dysfunction indications, cardiovascular and hypertension contraindications, and patient eligibility.
Oxytocin Intake Form
Free Oxytocin intake form template for sexual health and wellness clinics. Covers libido, stress, and bonding indications with cardiovascular and infection-related contraindications.
Oral ED Medication Intake Form
Free oral erectile dysfunction (ED) medication intake form template. Covers PDE5 inhibitor indications, cardiovascular contraindications, and priapism risk screening for sexual health clinics.
Penile Injection (Trimix / Bimix) Intake Form
Free penile injection (Trimix/Bimix) intake form template for urology and sexual health clinics. Covers ED indications, priapism risk screening, anatomical contraindications, and prior therapy history.
Trimix Refill Questionnaire
Free Trimix refill questionnaire template for penile injection therapy. Captures prior formulation, draw amount, erection firmness and duration, side effects, and phenylephrine availability.
Wellness & Longevity
Intake forms for NAD+, glutathione, methylene blue, LDN, and lipotropic programs.
Lipo / Vitamin B12 Intake Form
Free Lipo/B12 injection intake form template for wellness and weight loss clinics. Covers energy and metabolism indications, B12-related contraindications, and patient eligibility screening.
LDN Boost Intake Form
Free Low Dose Naltrexone (LDN) Boost intake form template for integrative and functional medicine clinics. Covers mood, energy, and appetite indications with cardiovascular and renal contraindications.
Glutathione Intake Form
Free Glutathione antioxidant intake form template for wellness and IV therapy clinics. Covers antioxidant and detox indications, allergy and pregnancy contraindications, and patient eligibility.
Methylene Blue Intake Form
Free Methylene Blue intake form template for functional medicine and cognitive health clinics. Covers brain fog and energy indications with critical serotonin syndrome and G6PD screening.
NAD+ Intake Form
Free NAD+ (Nicotinamide Adenine Dinucleotide) intake form template for longevity and wellness clinics. Covers energy, cognitive, and anti-aging indications with allergy and oncology contraindications.
Hair Loss
Intake forms for hair restoration programs including finasteride, regrow formulas, and GHK-Cu.
Regrow Fuel Hair Loss Intake Form
Free Regrow Fuel hair loss intake form template for hair restoration and wellness clinics. Covers male pattern hair loss indications, cancer and liver contraindications, and St. John's Wort screening.
Follicle Fuel Hair Loss Intake Form
Free Follicle Fuel hair restoration intake form template. Covers male pattern hair loss and sexual function screening, cancer and liver contraindications, and St. John's Wort drug interaction screening.
Finasteride Intake Form
Free Finasteride intake form template for hair loss and men's health clinics. Covers male pattern baldness indications, liver and prostate contraindications, and sexual side effect baseline screening.
General / Multi-Program
Screening questionnaires and consent forms that work across multiple program types.
Weight Loss Screening Questionnaire
Free weight loss clinic screening questionnaire template. Pre-qualify patients for GLP-1, semaglutide, and medical weight management programs. BMI calculator, comorbidity screening, and readiness assessment.
Med Spa Patient Intake Form
Free med spa patient intake form template covering weight loss, peptide therapy, and aesthetic treatments. Includes medical history, contraindication screening, and consent sections. Download and customize.
Telehealth Weight Loss Consent Form
Free telehealth consent form template for weight loss and GLP-1 programs. Covers telehealth-specific risks, technology requirements, state prescribing rules, and patient rights. Download and customize.
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