I hereby state that I understand I am purchasing a prescription required item. I have consulted a physician and received a prescription for the items I am purchasing.
*We have an Online Prescription Form available at http://colonialmedicalonline.com/images/urologicalrx.jpg . You can have the Rx faxed to 407-849-6458 or email to firstname.lastname@example.org
"The sale of this item may be subject to regulation by the U.S. Food and Drug Administration and state and local regulatory agencies. If so, do not purchase this item unless you are an authorized purchaser. If the item is subject to FDA regulation, I will verify your status as an authorized purchaser of this item before shipping of the item."