Request for Erythromycin Double-Strength 4% Topical Solution 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
symptoms do not improve to seek medical advice from a physician.
Within the USA, this product can
only be shipped to Florida residents.
Note to international clients:
Country selection is located on the payment & shipping page.
Date of Birth:
Are you pregnant or nursing a baby?
Medical Conditions or Chronic Diseases:
Chief Current Complaint (e.g.
long have you had this condition?
Blemishes are located on what
part(s) of the body?
What area(s) will you be using the
What else are you using to treat
did you hear about this website?
Patients approved for a prescription for erythromycin topical
solution are hereby advised that this product should not be used near