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My Prescription Drug list
Fill this form with all medications you are taking and I will run all plans to see which plan(s) will provide the best coverage for you. Don't forget to hit the submit button at the bottom when done.
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Your Name
*
Your answer
Your email address
Your answer
Who is your preferred doctor?
Your answer
What is your preferred pharmacy?
CVS
Rite-Aid
Walgreens
Walmart
Costco
Other:
Prescriptions, Dosage, and how many per day/month?
List all medications here. Example:
Losartan, 10mg, 1x
. Hit <ENTER> for a new line.
Your answer
Notes: Is there anything you think I should know while looking for plans?
Your answer
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