Step Request for Carbinoxamine 4mg Tablets Prescription:

This information is necessary in order to process your request for your prescription. Please answer all questions

completely and truthfully.  All fields are required.  Patients are advised that if after using the medication and

symptoms do not improve to seek medical advice from a physician.

 

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Notice:  We do NOT ship prescription medicines to residents of Missouri

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Patients are hereby advised that this product should not be used by patients with bronchial asthma or other lower respiratory symptoms, glaucoma, prostate conditions or urinary retention.  By clicking the continue button below I state that I have answered all questions truthfully to the best of my knowledge and ability.


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Your prescription, if approved, will be filled by our pharmacist. You will not be charged and your check or money order will be returned if it is determined by the pharmacist that your application should not be approved. Mail this page with your payment ($47.99 Rx + $5 professional fee + SHIPPING & HANDLING choice) check or money order payable to WebRx Pharmacy Palace to:

WebRx Pharmacy Palace

501 N. Beneva Rd, Suite 550

Sarasota, FL 34232

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If you would prefer to fax the information please print, click reset, and fax it to (941)296-7447 then click here to make payment.

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