Seating/Mobility Evaluation To be completed by Physiatrist or Physical/Occupational Therapist In Association With Mobility Device Specialist

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Hi,

First we’ll need to know a little more about you. The following sections help us determine if you’re eligible for basinger's pharmacy.

Setting Up Your account

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Your shipping address

We ship your medication right to your door. Where would you like to receive your first shipment?

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As your new pharmacy, we need to know more about you and your health. We only use this information to provide you with the best service possible, and never share it with anyone else.

Sex *
Are you pregnant? *
Add allergies
Add health conditions
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