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If you would like to register by mail or fax - you will need to fill out our registration form.
You can download that form by clicking on the link below. Please note that if you would
like faster service, please register online.
Download our Order Form
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Please download and print out our simple two page Patient Order Form.
The form collects your basic personal information; your physicians contact
information so we can confirm your prescription details; your payment information
and provides Patient Authorization that allows us to send you your prescription medication.
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