Rx Consent Form
Medication/Prescription Delivery
I give Woosh Delivery permission to transport and deliver my medications/prescriptions until further notice. *
Today's Date *
MM
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DD
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YYYY
Name *
Your answer
Birthdate *
MM
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DD
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YYYY
Address (please include name of city/town) *
Your answer
*Woosh Delivery can not be held responsible for pharmacy errors. Please contact your pharmacy with any concerns/issues. Do you Agree to these terms and conditions? *
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