I attached the template. Do everything in template file. Drug is Oral Contraceptive Drug.
I attached the example too of how to do it.
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Useful Links That Will Help You Around
Link to new order https://studentsolutionsusa.com/orders/stud/new
link to login page https://studentsolutionsusa.com/orders/login
New user registration link https://studentsolutionsusa.com/orders/register
Forgot Password https://studentsolutionsusa.com/orders/forgot/password