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zip code

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What is your date of birth?

HAVE YOU HAD A YEAST INFECTION BEFORE?

DO YOU HAVE ANY OF THE FOLLOWING? PLEASE CHECK ALL THAT APPLY

PLEASE CHECK ANY THAT APPLY TO YOU

DO YOU HAVE OTHER MEDICAL HEALTH ISSUES?

DO YOU HAVE ANY ALLERGIES?

ARE YOU CURRENTLY TAKING ANY MEDICATIONS? PLEASE INCLUDE OVER THE COUNTER MEDICATIONS AND HERBAL AND VITAMIN SUPPLEMENTS

TREATMENT

FLUCANAZOLE

PLEASE ENTER YOUR PREFERRED PHARMACY INFORMATION HERE

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Total Payment Value: $25.00