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Note: This form is being submitted using e-mail. You should have created a profile with an email editor such as Outlook Express in order to be able to submit the form. Please press the submit button only once. Since the form is submitted via email you will not receive an acknowledge receipt of your form. Please wait for the pharmacy to send you a confirmation.
Alternatively, send your prescription request to sharmanspharmacy@btconnect.com
Your request should contain your name and address, your doctor name and address and the items you request.
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