Rx Order Form Request

Are you a Provider?

Our Rx Order Forms make it easy to prescribe patient compounds for different conditions.

Submit this request form to get started.

Rx Order Forms

We make it easy for doctors to prescribe compounded medications through our Rx Order Forms. Based on condition or medication, we offer easy-to-fill prescriptions with preset drug options like dosages or forms. Just check the box for the options best for your patients and fax it in.

Form List

After Baby

Anti-Infective Nasal Delivery

Dermatology

Family Medicine

Female Personalized Medicine

Female Pain

Female Urology

Gastrointestinal Delivery

General OB/GYN

General OTIC - Conditions

Ketamine Treatment

Oral Mucosal Delivery

Anti-infective Otic Powder

Personalized Medicine

Post Tonsillectomy

Compounded Semaglutide Rx Order Form

Compounded Tirzepatide Rx Order Form

Pain Management

Veterinary

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GLP-1 Medications
Semaglutide and Tirzepatide

Shipping Available with Prescription