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WCRX HEALTH
Live Care Consultations
Live Consultation Timings:
Monday - Friday: 9am EST - 5pm EST.
Saturday: 9am EST - 1pm EST
States Allowed:
AL, AR, AZ, CA, CT, DC, DE, FL, GA, ID, IL, IN, KY, LA, MD, MI, MN, MS, NC, ND, NE, NJ, NV, NY, OK, PA, SC, TN, TX, VA, WA, WI, WV
Contact Us:
844-ASK-WCRX
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First Name
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Your answer
Last Name
*
Your answer
Gender
*
Male
Female
Required
Date Of Birth
*
MM
/
DD
/
YYYY
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Phone Number
*
Your answer
Email Address
Your answer
Insurance Name
*
Your answer
Medicare Id
*
Your answer
Social Number
Your answer
Have you had a physical for this year ?
Which year ?
*
Your answer
Do you have Alzheimer or Dementia ?
*
Yes
No
Required
Are you residing in nursing home
*
Yes
No
Height
*
Your answer
Weight
*
Your answer
Does patient diagnosed with Diabetic
*
Yes
No
Type 1 or
Type 2
*
Type 1
Type 2
How Many Times does patient test blood sugar daily?
*
Your answer
Does patient take Insulin
*
Yes
No
Required
How Many Times does patient take insulin ?
*
Your answer
What other health conditions does patient have?
Your answer
Doctor First Name
*
Your answer
Doctor Last Name
*
Your answer
Doctor address or phone number
*
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Pharmacy address or phone number
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