How to read this. A reference structure for a thorough first peptide consult, written for clinicians new to the modality or looking for a more deliberate workflow. Adapt to your practice. The eight-step skeleton below covers the decision points that pay off across most patient types.

Before the visit

If a pre-visit intake form exists, review it. The patient's stated goal, current medications, and relevant history determine whether you need additional labs ordered ahead of the visit or whether the visit itself drives the lab order. For a recovery-focused patient with a clean history, no pre-visit labs may be needed. For a GH-axis or weight-management consult, an IGF-1 or A1c-and-lipid panel beforehand makes the visit more productive.

Step 1: Open with the goal

Start with: What are you hoping will be different in 3 months? The patient's answer reveals whether peptide therapy is even the right framework, or whether they have arrived at it because of a social-media post that pointed them at a specific molecule.

Listen for goal categories: recovery, weight, sleep, libido, energy, skin, body composition, longevity. The category determines which molecules are even on the table.

Step 2: Targeted intake

Once the goal is named, run a targeted history rather than a comprehensive one:

• Onset, duration, and prior interventions for the stated complaint
• Current medications and supplements
• Relevant labs in the last 12 months
• Cardiovascular, oncologic, endocrine, and psychiatric history
• Allergies, including reactions to compounded or injected medications
• For weight-management consults: prior weight history, eating-disorder history, GI symptom baseline, gallbladder status
• For libido or sexual-function consults: relevant cardiovascular history, current sexual function baseline
• For GH-axis consults: cancer history (personal and first-degree family), pituitary history, sleep apnea

Step 3: Red-flag screen

Specific items worth screening explicitly because they change protocol selection or contraindicate categories of peptides:

• Active malignancy. GH-axis peptides and IGF-1 LR3 are typically deferred.
• Personal or family history of MTC or MEN-2. Contraindication for GLP-1 receptor agonists.
• Pregnancy or actively trying to conceive. Most peptides should not be initiated.
• Severe gastroparesis. GLP-1 receptor agonists may worsen.
• Pancreatitis history. Caution with GLP-1 receptor agonists.
• Uncontrolled hypertension or recent cardiovascular event. PT-141 and other vasoactive compounds need extra consideration.
• Active eating disorder. Weight-management protocols deferred.

Step 4: Goal-fit analysis

Map the goal to the candidate molecule(s). The Peptides by Goal reference can be used as a shared visual during this part of the conversation.

For most goals, the right answer is one molecule, or a two-molecule complementary stack. Avoid starting a patient on more than two compounds simultaneously unless there is a clear reason. Sequenced protocols produce cleaner attribution and better adherence.

Step 5: Propose the protocol

State the proposed plan in patient-comprehensible terms: the molecule, the dose, the schedule, the duration, and the reassessment point. Connect each piece to the goal:

"For your tendinopathy I am proposing BPC-157 by daily subcutaneous injection for 8 weeks. We will reassess at week 8 to decide whether to extend, switch, or stop."

For GH-axis or GLP-1 protocols, name the titration schedule explicitly. Patients who understand the titration are more likely to tolerate it.

Step 6: Set expectations

Three pieces:

• Time horizon. When will they notice anything? When is "not working yet" still expected? See the timeline framing in Talking to Patients About Peptides.
• Side-effect preview. What is normal, what warrants a call, what warrants the ER. Reference the patient-side article Side Effects: Expected vs Callback-Worthy.
• Evidence framing. One sentence on where this molecule sits on the evidence map. Patients find this easier to absorb during the consult than later.

Step 7: Cover logistics

The administrative pieces that decide whether the patient actually starts:

• Where the prescription is sent and when they should expect it
• Cold-chain handling on arrival (refrigeration, light, temperature excursion)
• Reconstitution if the formulation requires it
• Injection technique, with referral to the patient-side technique resources or a brief in-office walkthrough
• Cost framework, especially for compounded preparations not covered by insurance
• Any required labs (baseline or at the reassessment)

Step 8: Close with a clear next step

The final 90 seconds of the visit decide whether the patient leaves with confidence:

• Here is what we are doing and why.
• Here is when we will see each other again.
• Here is what to call about, and the easiest way to reach us.
• Here is what to expect to feel between now and then.

Patients who walk out repeating these four things back to themselves complete their courses at substantially higher rates.

Documentation checklist

At minimum, the consult note should capture:

• Stated goal and timeline expectation
• Targeted history elements relevant to the proposed protocol
• Red-flag screen and any contraindications evaluated
• The molecule selected, dose, schedule, duration
• The reassessment plan
• The evidence framing the patient was given
• Acknowledgment of compounded vs FDA-approved status of the chosen molecule
• Side-effect counseling provided
• Labs ordered (or rationale for none)

This documentation also forms the baseline for the reassessment visit, which is substantially easier to run when the first visit is captured cleanly.