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Across the street from CVS Pharmacy

805-382-2020
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Home » Contact Us » Medication List

Medication List

Prescription, over-the-counter, and herbal Medications; and Vitamins.

  • Please write down pills, injections, drops, etc. you use regularly. Please line through those you no longer use.

  • Name of medicationYear ( begun/changed)Strength/Amount (dosage)Times per DayReason for TakingYear (discontinued) 
  • Name of medicationYear ( begun/changed)Strength/Amount (dosage)Times per DayReason for TakingYear (discontinued) 
  • Name of medicationYear ( begun/changed)Strength/Amount (dosage)Times per DayReason for TakingYear (discontinued) 
  • Name of medicationYear ( begun/changed)Strength/Amount (dosage)Times per DayReason for TakingYear (discontinued) 
  • Name of medicationYear ( begun/changed)Strength/Amount (dosage)Times per DayReason for TakingYear (discontinued) 
  • Name of medicationYear ( begun/changed)Strength/Amount (dosage)Times per DayReason for TakingYear (discontinued) 
  • Name of medicationYear ( begun/changed)Strength/Amount (dosage)Times per DayReason for TakingYear (discontinued) 
  • Name of medicationYear ( begun/changed)Strength/Amount (dosage)Times per DayReason for TakingYear (discontinued) 
  • Name of medicationYear ( begun/changed)Strength/Amount (dosage)Times per DayReason for TakingYear (discontinued) 
  • Name of medicationYear ( begun/changed)Strength/Amount (dosage)Times per DayReason for TakingYear (discontinued) 
  • Name of medicationYear ( begun/changed)Strength/Amount (dosage)Times per DayReason for TakingYear (discontinued) 
  • Name of medicationYear ( begun/changed)Strength/Amount (dosage)Times per DayReason for TakingYear (discontinued) 
  • Name of medicationYear ( begun/changed)Strength/Amount (dosage)Times per DayReason for TakingYear (discontinued) 
  • Name of medicationYear ( begun/changed)Strength/Amount (dosage)Times per DayReason for TakingYear (discontinued)