Holiday Period: Interim Medication Request Form
GUIDE FOR SUBMISSIONS
  • **Please only share a request if you will run out of medication over the holiday period and do not have an active script or medication available which can be filled**
  • A clinician will review requests with consideration of each patient's protocols and expected remaining medication.
  • Updates will be provided via email usually within 3 working days once requests are processed
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First Name *
Last Name *
Email Address Linked With CactusMen Account *
Reason For Interim Medication Request *
Please List Interim Medication(s) Requested *
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