Please list your Prescription Drugs (Names, Dosages, and Number of Times per Day).
DO NOT include OTC supplements or other OTC medications. If you use insulin, please tell us the number of vials of insulin or number of pens you use per month, not the number of units you take per day.
**Please be sure to check the spelling of the medication names, dosages, etc. you list on this form so that we can make accurate recommendations.
One of the most common errors we see is in the omission of letters after the name of a medication such as ER or XL, which are very important in comparing medications. We ask that you copy your information directly from your prescription bottles to avoid any confusion.
Examples: Seroquel-XR 50 mg 1 x/day. Lantus 10ml vial, 2 vials/month. Lantus Solostar 3ml Pen, 5 pens/month.