Name:  _________________________________

Address:   _____________________________________________________

Phone No.  __________________________

Dear Pharmacist:

My doctor has prescribed the BTA stat Test as part of my healthcare management.

I am requesting that you stock the test at your pharmacy.

If you are unfamiliar with the test, more information is available at the web site www.btastat.com. You can also contact customer service at Polymedco, inc., (800-431-2123) for information or to order the test.

Please call me to discuss your decision on this matter.

Thank you.

Sincerely,