PLEASE ANSWER THE FOLLOWING QUESTIONS TO THE BEST OF YOUR KNOWLEDGE:

HAVE YOU SPOKEN TO YOUR DOCTOR WITHIN THE PAST THREE MONTHS REGARDING YOUR CURRENT MEDS: (required)
YESNO

HAVE YOU SPOKEN TO YOUR PHARMACIST WITHIN THE PAST THREE MONTHS REGARDING YOUR CURRENT MEDS: (required)
YESNO

ARE ALL OF YOUR MEDICATIONS CURRENTLY BEING FILLED AT ONE (1) PHARMACY: (required)
YESNO

WOULD YOU LIKE TO SPEAK TO ONE OF OUR PHARMACISTS REGARDING YOUR MEDICATIONS: (required)
YESNO

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