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TRIMIX RX UPLOAD

 

 

Before uploading a prescription here you must first verify that you have a valid prescription from your primary physician or your local urologist. 

Have your physician complete the form below and upload scanned image of your prescription.

 

Trimix Order Form

 

Fax your prescription to        954-839-9039

Email your prescription to     rx@zionpharmacy.com

 

 

Complete the following form below:

 

Prescribing Physician Name (required)

Patient Full Name (required)

Full Address, city, state and ZIP (required)

Contact Phone (required)

Your Email (required)

Prescription #1 Upload

Prescription #2 Upload

Prescription #3 Upload

Subject

Your Message


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.                 

 

 

 

 

 

 

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