Edgewood Center Pediatrics
8896 Commerce Road, Suite 5
Commerce Township, MI 48382
Ph - 248-360-9241
Fax - 248-360-0830

Preferred family Pharmacy

All prescriptions are required by state law to be sent electronically.

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Patient name:

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Patient name:

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Preferred pharmacy name and phone #:

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Typed Name

Parent/Patient/Guardian signature: