Step Request for Famotidine 40mg 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 and

symptoms do not improve to seek medical advice from a physician.

 

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list what you will use.  If no, please write "none".

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Patients approved for a prescription for Famotidine are hereby advised that if symptoms do not improve while using this medication that it may

be a sign of a serious condition and should seek appropriate medical attention.

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