Rx Specialty Services, Inc.
   National Patient Advocacy Group

National Patient Advocacy Group

Contact Information

If you need assistance with your medications, please fill out the form below.  We will contact you within 2 business days of receiving your request.

First Name:
Last Name:
Address Street 1:
Address Street 2:
Zip Code: (5 digits)
Daytime Phone:
Doctor's Name:
Doctor Phone:
Medication List:
Please list out each
medication, mg, how
often you take it, & the
Doctors name & phone

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