New RX Order Upload
PLEASE NOTE: WE DO NOT FILL PRESCRIPTIONS WRITTEN BY THE PROVIDER, FOR THE PROVIDER. It might be legal, but it is not something we do.
All prescriptions submitted by anyone other than the provider (or representative of the provider) will be verified with the provider signing the prescription prior to filling.
Please do not attempt to commit fraud.
Provider's Name
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First Name
Last Name
Prescription Submitter's Email
*
legalprovider@legalprovider.com
Provider License Number, NPI, or DEA #.
*
Yep, we had to add this on 10/30/2024
Upload Signed Prescriptions Here
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of
Special notes or Valid Medical Rationale* (*for veterinary patients):
Leave blank if none.
Patient phone number (if not included on RX document):
If there's no phone number, we have no one to call.... *sniff*
Doctor's Signature
*
Please verify that you are human
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Submit
Submit
Should be Empty: