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LEE SILLY COMPOUNDING PHARMACY WOMEN HEALTH Rx ORDER FORM Practitioner: Phone: Fax: Address: Patient Name: Birth Date: / / Address: Phone: ESTROGEN Vitriol (E3) / (E2) TD Cream Capsules Vaginal Cream

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1. Begin by gathering all necessary information and documents. Make sure you have the required forms, identification, and any supporting documents that may be needed.
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4. Fill in any required fields or sections related to your specific situation. For example, if the form requires information about your employment or educational background, ensure you provide the correct details.
5. Pay close attention to any date fields or signatures that may be required. Make sure to write the dates correctly and sign where necessary. Verify that all signatures are legible and match the name provided.
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