My medication has not been approved. Personal InformationName* First Last Email Phone*Your Attorney*James “Marty” SternMichael K. WaxCase InformationList the medications not approved:* Who prescribed the medications above?*When did you submit the prescription?* The pharmacy name you took the prescription to:*The pharmacy's phone number you took the prescription to:*Terms And ConditionsAgreement* I have read, understand and agree to the Terms and Conditions
