Pawtuxet Valley Prescription & Surgical Center - Apothecare

"Quality care for ALL your medical needs"

Types of Preparations	Flavors Available	Wound Care Applications	Pediatric Applications	General Care Applications	Geriatric Applications

Terminally Ill Hospice Care Applications	Hormone Replacement Therapy	Veterinary Animal Care Applications	Dermatology Skin Care Applications	FAQ's Frequently Asked Questions	Request For Additional Information

IMPORTANT: We will not be able to respond unless you fill in Your Name, the E-Mail, and the Request / Inquiry fields. Thank you.

If you are the physician, please check this box.
If your are the patient, or, just requesting information, please check this box.

Your Name:

PATIENT INFORMATION:

Patient's Name:
Address (Line 1):
Address (Line 2):
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PHYSICIAN INFORMATION:

Physician's Name:
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PLEASE DESCRIBE YOUR REQUEST / INQUIRY:



E-Mail Address:
***Our automatic responder will send a copy of your E-Mail inquiry (as confirmation of receipt) to the E-Mail address which you use to send your inquiry. If you send an inquiry from an E-Mail address which is not your own, please do not reveal any confidential information in your inquiry which you do not want revealed to the owner of the originating E-Mail address. We attempt to maintain confidentiality in all communications. If you cannot send an inquiry from "your own" E-Mail address, please print out this form and fax it to us at: 1-877-266-7686.

How would you prefer that we respond? Tel Fax E-Mail May we communicate with your Doctor regarding your inquiry? Yes No If yes, have you provided us with your Doctor's contact information? Yes No

We strictly adhere to the "TRIAD" philosophy which mandates a permanent level of communication between the "Patient - Physician - Pharmacist".

We invite you to review the information posted on our web site.
We think you will find that dealing with one supplier for all your medical needs
provides a primary link between patient-physician-insurer-service provider.

"We believe in quality care for ALL your medical needs."

If you have any questions about the types of services we have to offer,
Please contact us with your questions.

Leo R. Blais, R.Ph. BS Beverly Blais, CPhT / Compounding Specialist Denise DeGraide, CPhT / Compounding Specialist
59 Sandy Bottom Road Coventry, Rhode Island 02816 E-Mail: LRB@PVPSC.com URL: http://www.PVPSC.com	Tel: (401) 821-5000 Toll Free Nationwide: 1-888-240-7879 Fax: 1-877-COMPOUND Fax: 1-877-266-7686

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