Are there other individuals in your immediate household who you'd like to become prescription patients at St. Paul Corner Drug? If so, please enter their name, date of birth, their relationship to you, and any maintenance medications they take (i.e., prescriptions they regularly fill). When including the names of maintenance medications, use the exact name that's listed on their prescription bottle (e.g., don't write "Synthroid" if they actually take Levothyroxine, the generic version of this medication).