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Cyclobenzaprine , 10mg × 90 Tablets

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Medical Questionnaire
1. I agree not to take any over-the-counter medicines without approval from my pharmacist
2. Agree not to take medication if I am pregnant, breast-feeding, or trying to get pregnant.
3. Please list all current medical conditions including high blood pressure. Choose "None" if none.
4. Is there anything in your medical history that you consider to be relevant? If yes, please specify. Choose "None" if none.
5. Please list all over-the-counter and prescription medications that you are currently taking and the length of time for each.Choose "None" if none.
6. Please list all medications that you plan to take while on this program. Choose "None" if none.
7. Please list all past or present allergies including allergies to any medications. Choose "None" if none.
8. Please list all past surgeries and provide details including the condition that was treated with each surgery. Choose "None" if none.
9. Please explain the specific medical reason for ordering this medication. The physician must know the exact nature of your medicalproblem in order to prescribe this medication. This cannot be left blank.


The information in this database for Cyclobenzaprine is intended to supplement, not substitute for, the expertise and judgement of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects for Cyclobenzaprine, nor should it be construed to indicate that use of a Cyclobenzaprine is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.