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Erectile Dysfunction Physician Referral Form

 

Need to see a doctor in your area? 

 

Ask for a referral to a physician’s office in your area by filling out the following form:

 

 

[contact-form-7 id=”903″ title=”HRT Referral”]

 

 

Zion Clinical Pharmacy verifies all prescriptions with prescribing physicians as well as the validity of licenses including the DEA license. No controlled substances will be dispensed through this system! Zion Clinical Pharmacy will report suspicious elicit attempts to illegally access prescribed medication (in accordance with all rules and regulations).

 

♦ By using this you are agreeing that you are the patient to whom the RX was prescribed. 

 

♦ Furthermore, you certify the prescription was given to you by a licensed physician, following a face to face visit, where you were examined and furnished with the Rx to treat a specific medical condition.     

 

Buy Trimix Products

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Discreet Trimix Carrier

Ultimate Trimix Kit

Penile Band

LEGAL NOTICE

Zion Clinic Pharmacy complies with all the requirements of the Ryan Haight Online Pharmacy Act. Zion Clinic Pharmacy will only dispense a controlled substance to a person who has a valid prescription from a Florida licensed physician issued for a legitimate medical purpose based on a medical relationship with a prescribing practitioner. This includes at least one prior in-person medical evaluation in accordance with applicable requirements of section 309 of the Controlled Substances Act (21 U.S.C. 829). Zion Clinic Pharmacy will not fill any prescription based on an online questionnaire alone.

LEGAL NOTICE

The contents of this website are intended for informational use only. It is not intended to or designed to provide medical advice, professional diagnosis, treatment services or to replace your physician’s medical care. Information about the drug products contained on the website does not cover all possible uses, actions, precautions, side effects or interactions. Please consult your medical doctor before making any decisions concerning your health. All medications are compounded in a licensed compounding facility under the direct supervision of licensed pharmacist using FDA approved ingredients and in compliance with Florida State Board of Pharmacy regulations. All products are dispensed for individual patient use pursuant to a patient-specific prescription from a licensed physician.