Erectile Dysfunction Physician Referral Form

To get a referral for a physician in your area please fill the following form

Comments or questions are welcome.

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Zion Clinical Pharmacy verifies all prescriptions with prescribing physicians as well as 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 illegaly access prescribed medication (in accordance to 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 a the rx to treat a specific medical condition.

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