Pharmacy Solutions - RX Compound

817.274.0050

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Men Health

Men's Health Order Form

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PATIENT INFORMATION

ALPROSTADIL

Product Injectable
Empty Product Injectable

PAPAVERINE, PHENTOLAMINE

Product Bi-Mix
Product Bi-Mix
Empty Product Bi-Mix

PAPAVERINE, PHENTOLAMINE, PROSTAGLANDIN E1 (PGE1)

Product Tri-Mix
Product Tri-Mix
Product Tri-Mix
Product Tri-Mix
Product Tri-Mix
Product Tri-Mix
Product Tri-Mix
Empty Product Tri-Mix

PAPAVERINE, PHENTOLAMINE, PROSTAGLANDIN E1 (PGE1),ATROPINE

Product Quad-Mix
Empty Product Quad-Mix
SIG
as measured on syringe intercavernously.

ORAL PRODUCTS

Product Oral
Product Oral
Product Oral
Product Oral
Product Oral
SIG
tablets 30 minutes prior to sexual activity

NASAL SPRAY

Product Nasal
SIG: 1-2 sprays in nostril prior to sex

TOPICAL HORMONE REPLACEMENT CREAM

Product Topical
SIG: Apply 1gm to upper arm or shoulder daily.

PHYSICIAN INFORMATION

Clear Signature
Pharmacy Solutions - RX Compound

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Pharmacy Solutions - RX Compound

Pharmacy Solutions
1921 W Pioneer Pkwy,
Arlington, TX 76013

Click here for driving directions.

Pharmacy Solutions - RX Compound

ATTENTION!

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Fax your order form to 817-860-6083 for processing.

Pharmacy Solutions - RX Compound

WE DELIVER TO THE FOLLOWING STATES:

ARIZONA | COLORADO | FLORIDA | GEORGIA | ILLINOIS  KENTUCKY | LOUISIANA | MISSOURI | NEVADA
NEW YORK | OKLAHOMA | TEXAS

If you have any questions, please call us.

TOLL-FREE: 800-542-5767
PHONE: 817-274-0050

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