Please include the EXACT name of the medication as it appears on your prescription bottle/container. Please include the TYPE (tablet, capsule, injection, inhaler, etc), the DOSE of the med, the FREQUENCY (how often you take the med - daily, twice daily, etc), the AMOUNT in one prescription and HOW OFTEN you have it filled (30 days, 90 days, twice a year, etc).
Please do NOT include over the counter medication such as vitamins, Tylenol, Advil, etc.
*If you do NOT take any prescription medications, please type NONE in the box below.*
Please enter information like this: Name of Medication - Type - Dose - Frequency - Amount - How often filled