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Fax 1-800-378-0323 PRESCRIBER SERVICES New Prescription Request FastStart Fax Form The following information is necessary in order to process your patient s prescription s. Step 3 Physician Information Required Dr. Name Fax - Step 4 Fax information toll-free to 1-800-378-0323 If you are not the intended recipient of this FAX you are hereby notified that any disclosure copying or distributing is prohibited. If you have received this FAX in error o....

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