Prescriber Prescription Request

IF YOU ARE A PATIENT REQUESTING A PRESCRIPTION

START HERE

Prescriber Prescription Request

Start processing your order by completing the form below. Note: we also accept ePrescribe requests. 

If you would like to fax your prescriptions, fax completed forms to 1-844.705.0156.

Due to state and federal laws, a member of our pharmacy staff will call to confirm prescriptions. Thank you for understanding!