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Please select: Please select: I would like to order a prescription

name and dose of medication

name and dose of medication

name and dose of medication

name and dose of medication

name and dose of medication

name and dose of medication

name and dose of medication

name and dose of medication

name and dose of medication

name and dose of medication

I would like my prescription / referral I would like my prescription / referral I will pick it up myself I would like to have it sent to my address listed in my file

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