Ordering Instructions:

Please follow instructions to avoid order delays.

• Use the order form for the physician accountable to receive the order.
• Include a CLEARLY PRINTED second sheet with additional prescribers to be included on the pad. Include all DEA and License numbers.
• We DO NOT require a copy of your DEA registration. Rx Security checks each DEA and license automatically.
• We can include no more than 6 prescribers and one address per script.

Print order form to fax order