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Refill to Local Pharmacy(Medication is not included)

Medication(s) being Requested
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Pharmacy Name/Address
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Blood Pressure
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Heart Rate
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Current Weight/Height:
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Day Supply
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I understand this request will not be fullfilled for any weightloss prescriptions. Initial
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Product Details

THIS IS OUR FEE TO SEND YOUR MEDICATION TO THE PHARMACY

THIS DOES NOT INCLUDE THE COST OF YOUR MEDICATION FROM THE PHARMACY.

THIS IS NOT FOR ANY WEIGHT LOSS MEDICATION.

Please understand this process is necessary to document a proper note, cover administrative fees, and maintain compliance with my supervising physician's requirements.

Once we confirm you are a current patient seen within the last 60 days with the necessary labs on file we will send your prescription to the local pharmacy.

You must also ensure your ID is on is on file in Optimantra. No exceptions.

Please allow 48 hours for medications to be sent to local pharmacies.You will be sent a notification once medication is sent.

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Refill to Local Pharmacy(Medication is not included)
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