Consent Form Templates
Professional consent form templates for peptide therapy prescribers. Download, customize with your practice information, and print for patient use.
Legal Disclaimer
These templates are provided as educational resources and starting points only. They are not legal documents until reviewed and approved by your legal counsel. Before using any consent form:
- Have your attorney review and approve all language
- Customize for your state's specific requirements
- Ensure compliance with your malpractice carrier's recommendations
- Update placeholder fields with your practice information
- Review regularly for changes in regulations or best practices
General Peptide Therapy Consent
Comprehensive consent form covering the basics of peptide therapy including mechanism of action, expected outcomes, potential risks, and alternative treatments.
Use for any peptide therapy initiation. This serves as the foundation consent that can be supplemented with specific peptide addendums.
GLP-1 Agonist Specific Consent
Detailed consent specifically for semaglutide, tirzepatide, and other GLP-1 receptor agonists. Includes boxed warning content, weight loss expectations, and GI side effect counseling.
Required for all patients initiating GLP-1 therapy. Addresses specific FDA warnings including thyroid C-cell tumor risk and pancreatitis.
Off-Label Use Disclosure
Informed consent for off-label prescribing. Explains what off-label use means, why FDA approval may not exist for specific indications, and documents patient understanding.
Use when prescribing any peptide for an indication not specifically approved by the FDA, or when using off-label dosing protocols.
Compounded Medication Consent
Consent form specifically addressing compounded medications. Covers the difference from FDA-approved products, quality considerations, and 503A/503B pharmacy distinctions.
Required when prescribing any compounded peptide. Helps patients understand the regulatory framework and quality standards for compounded medications.
How to Use These Templates
1. Download & Review
Click the download button to open the form in a new browser tab. Review all content to ensure it aligns with your practice needs.
2. Customize
Replace all [BRACKETED PLACEHOLDERS] with your practice information. Add or remove sections as appropriate for your patient population.
3. Legal Review
Have your healthcare attorney review the customized form. Ensure compliance with state and federal requirements.
4. Print & Use
Use your browser's print function (Ctrl/Cmd + P) to print or save as PDF. The forms are designed to print cleanly on standard letter paper.
Need a consent form for a specific peptide or situation?
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