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| Ordering Directions |
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Patient Information - Enter the Patient's Personal &
Billing Information.
List all of the prescribed medications in the table.
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Please note: invoice will reflect Canadian dollars, credit card statement will reflect US dollars. |
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Physician Information - Please list the Physician Information including the DEA # and License information.
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Prescription Information - Please list the Prescription Information
including the Strength, Quantity, etc...
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Sending Your Information - Fax completed forms to us at: Toll Free (1-866-771-7716).
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Ordering Forms
2 forms are required to
place an order. |
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Click Here
to print out the Patient Health Profile and Ordering Form.
You may place your order by mail
or fax. (Printer Friendly) |
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