Printable Forms

These prescription forms are used to place new orders or to refill orders.

Prescription Fax Coversheet

Print one for each prescription in your order and attach your doctor's prescription to each sheet where indicated (use scotch tape). Refill orders only require this form if the previous prescription has expired.

FAX Order Form

For orders sent in by FAX. Those entering online orders do not require this form.


Fax the above prescription form(s) to our toll-free fax number 1-866-290-2272. Or scan and e-mail to We will process your order and email you a confirmation. Please allow three days for processing before contacting us to follow up on your order