|
ORDERING PRESCRIPTIONS:
Thank you for your interest in our prescription service. In order to fill your prescription, we will require all four forms listed below:
List of Forms
Online Submission
1. Patient Release Form
2. Patient Information Form
(Secure Page)
3. Medical Questionaire
(Secure Page)
4. Online Order Form (e-mailed) (Secure Page)
Fax or Mail the Forms
PDF format
1. Patient Release Form
2. Patient Information Form (Secure Page)
3. Medical Questionaire (Secure Page)
4. Order Form (Faxed / Couriered) (Secure Page)
In order to download and view PDF files, you will need Acrobat Reader. Please click on the icon below to get it.
Fax or Mail us all the information as required (except for the forms you have submitted Online.)
Charges :
Physician Review fees are included in our prices.
Shipping Charges are $15 per package and NOT PER DRUG.
|
