Prescription Refill Form

Name*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Prescription Pickup Location*
What is your Prescription?*
What is the Dosage?*
Desired Pick-Up Date*
Date Format: MM slash DD slash YYYY

(YWC must be given 24hrs to verify prescription request and prepare for the patient)
Desired Pick-Up Time*
(YWC must be given 24hrs to verify, prepare and send prescription request)
Name of Pharmacy Prescription Should be Sent to*
Address of Pharmacy*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

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Hormone Replacement Therapy

August 27, 2019

I experienced several health issues including colon cancer, and problems/severe pain with my shoulder. I did have three (3) surgeries for the colon cancer, and then shoulder surgery was recommended to me. I received a referral to the Wellness Center by my physical therapist, who reported that she thought all of my health issues were hormone related. I would have never thought such a thing!
I followed up with her recommendation and scheduled an appointment with the Wellness Center. I was informed by Judy Couch how all of my health issues could be hormone related. All of my doctors were in total agreement. There is now no trace of my colon cancer! And my shoulder surgery was cancelled! I feel as if all of the needed information was given up front, when I attended my initial consultation with Judy.
Hormone replacement therapy has made a tremendous difference in my life!! I hardly ever have a day where I do not feel well now! I feel better than I ever have! I would highly recommend hormone replacement therapy to others!!
A firm believer!
Rosalind A. Freeman

Rosalind A. Freeman