Reorder Form Name* First Last Date of Birth* MM slash DD slash YYYY Phone*Email* Sildenafil - 150mg SIL Troche SIL Rapid Desolving Tablet (RDT) QuantityVardenefil - 75mg VAR Troche VAR Rapid Desolving Tablet (RDT) QuantityTadalafil - 6.25mg / 75mg TAD 6.25mg Troche TAD 6.25mg RDT TAD 75mg Troche TAD 75mg RDT QuantityTrimix - Injectable Medication Trimix Quantity
