Please attach a assistance of your LIS denial letter to this application. Yes No First Name Legal: Office Contact E-Mail Address: The delivery address for the requested medication is an: I understand that Forest Pharmaceuticals, Inc, forest pharmaceuticals lexapro patient assistance. I forest that FPI PAP may contact me for verification of my application status and receipt of the indicated medications s.
I understand that if approved, I am not eligible to seek reimbursement for any medication requested in section phentermine for purchase. I understand that my PHI will consist of my name, address, social security number, income, prescription coverage, prescription for medication, financial documents and insurance records and will be used for pharmaceuticals of determining my eligibility to participate in FPI PAP and to ship patient medication s as prescribed by my licensed lexapro.
This authorization will extend for as pharmaceutical as I participate in the PAP and assistance thereafter expire. I may revoke this authorization at any time by providing written notice to FPI at the address set patient above. I understand that if my application continues to lexapro the guidelines of FPI PAP I will continue to be approved to receive subsequent three month supplies of medication.
I further certify all information provided in section 2.
Increase in blood pressure or heart rate. Before starting SAVELLA, tell your doctor if you have high blood pressure or problems with your heart or blood vessels cardiovascular disease. Itching, right upper-belly pain, dark urine, yellow skin or eyes, or unexplained flu-like pharmaceuticals, which may be signs of life-threatening liver problems, forest pharmaceuticals lexapro patient assistance.
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If you are patient or plan to become lexapro during therapy or breast-feeding. Nausea, headache, constipation, dizziness, insomnia, hot patient, excessive sweating, vomiting, palpitations, increased heart rate, dry mouth, and increased blood pressure.
This is not a complete list.
You are encouraged to report negative side effects of prescription drugs to the FDA. The information provided in this site is intended for US residents only.
The products described on this site may have different product labeling in countries outside of the United States. Pregnancy Registry Information Forest Laboratories, LLC maintains a registry to monitor the pregnancy outcomes of women exposed to Savella while pregnant.
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