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* 1. Your Name

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* 2. Title

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* 3. City of Practice

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* 4. Have you had any difficulty with obtaining B12 medication for your patients? If yes, please feel free to add detail. For example, I have had to go to 3 different pharmacies because the other 2 stopped shipping into California.

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* 5. How have you observed therapeutic benefit or improvement from the prescribed use of our B12 medication? Please add specific examples of improved functioning or value added to your patient’s lives. Our pharmacy is working to advocate that this therapy remain available to prescribers for their patients.

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* 6. Have you had any safety or quality concerns during your prescribed use of our B12 medication?

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* 7. Are you willing to share a photo to personalize your prescriber testimony?

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