Order Form Builder | Technician Dashboard | Bayview Pharmacy | Your Compounding Pharmacy of Choice

Home

Prescribe

Your Order Form

Compound Catalog Popular Order Forms

Staff

Compound Catalog

Order Form w/ Formulas

Custom Order Form Popular Order Forms Send Order Forms Documents Peptides Assessments

Prescribers

Tutorials

Settings

My Account Support Log Out

1

Search for medications or formulations to prescribe.

2

Click Order Medication and fill out order form.

3

Print and fax it to the pharmacy at 401-284-4506.

Need help?

Visit the Tutorials tab to learn more.

First

Last

Optimized for desktop use.
Please view on a larger screen to use this tool.

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.

1

Circle for steps.

Patient Information

Last Name

First Name

MI

Address

Apt. #

City

State

ZIP

Phone #

Date of Birth

Sex

Male

Female

Email

Patient will pick up at pharmacy

Please ship to patient

Please ship to office

2

Circle for steps.

Prescriber and Prescription Information

Prescriber's First Name

Prescriber's Last Name

Phone Number

Fax Number

Address

City

State

ZIP

NPI/DEA

Add

Adding

Radio 3

CheckboxProgesterone 75 mg Rapid Dissolve Tablet

Add

Adding

Radio 3

CheckboxProgesterone 100 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxProgesterone 100 mg Capsules (Gluten Free/Peanut Oil Free)

Add

Adding

Radio 3

CheckboxProgesterone 100 mg Rapid Dissolve Tablet

Add

Adding

Radio 3

CheckboxProgesterone 100 mg Troche

Add

Adding

Radio 3

CheckboxProgesterone 100 mg/Gm Topical Cream

Add

Adding

Radio 3

CheckboxProgesterone 100 mg/5 ml Oral Suspension

Add

Adding

Radio 3

CheckboxProgesterone 100 mg Suppository

Add

Adding

Radio 3

CheckboxProgesterone 30 mg/ml Topical Cream

Add

Adding

Radio 3

CheckboxProgesterone 50 mg/Gm Topical Gel

Add

Adding

Radio 3

CheckboxProgesterone 50 mg Rapid Dissolve Tablet

Add

Adding

Radio 3

CheckboxProgesterone 25 mg Capsules

Add

Adding

Radio 3

CheckboxProgesterone 50 mg Troche

Add

Adding

Radio 3

CheckboxProgesterone 50 mg Suppository

Add

Adding

Radio 3

CheckboxProgesterone 25 mg Rapid Dissolve Tablet

Add

Adding

Radio 3

CheckboxProgesterone 50 mg Capsules

Add

Adding

Radio 3

CheckboxProgesterone 25 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxProgesterone 30 mg/Estriol 1 mg Vaginal Suppository

Add

Adding

Radio 3

CheckboxProgesterone 50 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxProgesterone 25 mg Troche

Add

Adding

Radio 3

CheckboxProgesterone 50 mg Troche

Add

Adding

Radio 3

CheckboxProgesterone 25 mg Suppository

Add

Adding

Radio 3

CheckboxProgesterone 20 mg/0.25 ml Topical Cream

Add

Adding

Radio 3

CheckboxProgesterone 10 mg/Gm Topical Gel

Add

Adding

Radio 3

CheckboxProgesterone 20 mg/Gm Topical Cream

Add

Adding

Radio 3

CheckboxProgesterone 3%/Estriol 0.1% Vaginal Gel

Add

Adding

Radio 3

CheckboxProgesterone 5% Topical Cream

Add

Adding

Radio 3

CheckboxProgesterone 2%/Spironolactone 0.5%/Vitamin E Acetate 0.5% Topical Oil

Add

Adding

Radio 3

CheckboxProgesterone 10 mg/0.1 ml Sublingual Suspension

Add

Adding

Radio 3

CheckboxProgesterone 4% Topical Cream

Add

Adding

Radio 3

CheckboxProgesterone 25 mg Troche

Add

Adding

Radio 3

CheckboxProgesterone 10 mg/Gm To 200 mg/Gm Topical Cream

Add

Adding

Radio 3

CheckboxProgesterone 3% Topical Cream

Add

Adding

Radio 3

CheckboxProgesterone 10% Vaginal Gel

Add

Adding

Radio 3

CheckboxProgesterone 20 mg/ml Nasal Spray

Add

Adding

Radio 3

CheckboxProgesterone 2% Topical Facial Cream

Add

Adding

Radio 3

CheckboxProgesterone 1.6%/Vitamin E Acetate 40 U/ml Topical Cream

Add

Adding

Radio 3

CheckboxPregnenolone 100 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxPregnenolone 10 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxPregnenolone 25 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxPregnenolone 75 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxProgesterone 2% Sublingual Drops

Add

Adding

Radio 3

CheckboxPregnenolone 200 mg/5 ml Oral Suspension

Add

Adding

Radio 3

CheckboxProgesterone 1%/Magnesium Sulfate 5%/Melatonin 0.1% Topical Cream

Add

Adding

Radio 3

CheckboxProgesterone 2% Topical Gel

Add

Adding

Radio 3

CheckboxPrednisone 40 mg Suppository

Add

Adding

Radio 3

CheckboxPregnenolone 50 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxPrednisone 5 mg/0.1 ml Topical Gel (Vet)

Add

Adding

Radio 3

CheckboxPrednisolone 0.625 mg/0.1 Gm To 7.5 mg/0.1 Gm Topical Lipoderm® (Vet)

Add

Adding

Radio 3

CheckboxPrednisolone 10 mg/ml Oral Suspension (Vet)

Add

Adding

Radio 3

CheckboxPrednisolone 1 mg/ml To 10 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxPrednisolone 10 mg/0.1 ml Topical Gel (Vet)

Add

Adding

Radio 3

CheckboxPrednisone 5 mg/ml Oral Suspension (Gluten Free)

Add

Adding

Radio 3

CheckboxPrednisolone 50 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxPrednisolone 5 mg/0.1 ml Topical Gel (Vet)

Add

Adding

Radio 3

CheckboxPrednisone 0.5 mg/ml Oral Solution

Add

Adding

Radio 3

CheckboxPrazosin 1 mg/ml Oral Suspension (Vet)

Add

Adding

Radio 3

CheckboxPrednisone 5 mg/ml Oral Suspension (Vet)

Add

Adding

Radio 3

CheckboxPrednisone 10 mg/0.1 ml Topical Gel (Vet)

Add

Adding

Radio 3

CheckboxPramoxine HCl 1%/Zinc Oxide Topical Ointment

Add

Adding

Radio 3

CheckboxPotassium Citrate 500 mg/ml Oral Solution (Vet)

Add

Adding

Radio 3

CheckboxPotassium Chloride 20% Oral Liquid (Gluten Free)

Add

Adding

Radio 3

CheckboxPovidone-Iodine 5% Topical Gel

Add

Adding

Radio 3

CheckboxPramoxine HCl 1% Topical Cream

Add

Adding

Radio 3

CheckboxPramoxine HCl 1%/Clioquinol 0.75%/Hydrocortisone 0.25% Topical Lotion

Add

Adding

Radio 3

CheckboxPotassium Citrate 550 mg/5 ml/Sodium Citrate 500 mg/5 ml/Citric Acid 334 mg/5 ml Oral Solution

Add

Adding

Radio 3

CheckboxPotassium Iodide 65 mg/ml Oral Syrup

Add

Adding

Radio 3

CheckboxPotassium Gluconate 585 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxPotassium Iodide 2.5%/Iodine 2% Topical Solution

Add

Adding

Radio 3

CheckboxPovidone-Iodine 2%/DMSO Topical Gel

Add

Adding

Radio 3

CheckboxPramoxine HCl 1%/Naltrexone HCl 0.5% Topical Lotion

Add

Adding

Radio 3

CheckboxPotassium Citrate 1100 mg/5 ml/Citric Acid 334 mg/5 ml Oral Solution

Add

Adding

Radio 3

CheckboxPotassium Iodide 65 mg Capsules

Add

Adding

Radio 3

CheckboxPramoxine HCl 1%/Zinc Oxide 12.5%/Lidocaine 5% Rectal Gel

Add

Adding

Radio 3

CheckboxPramoxine HCl 1%/Zinc Oxide 5% Topical Cream

Add

Adding

Radio 3

CheckboxPotassium Iodide 300 mg Capsules

Add

Adding

Radio 3

CheckboxPotassium Iodide 10%/Iodine 7% Strong Tincture

Add

Adding

Radio 3

CheckboxPramoxine HCl 1%/Hydrocortisone 1% Topical Gel (Vet)

Add

Adding

Radio 3

CheckboxPotassium Gluconate 4.68 Gm/15 ml Oral Elixir

Add

Adding

Radio 3

CheckboxPramoxine HCl 1% Topical Lotion

Add

Adding

Radio 3

CheckboxPotassium Iodide 130 mg Capsules

Add

Adding

Radio 3

CheckboxPotassium Gluconate 2 meq/2.5 ml Oral Gel (Vet)

Add

Adding

Radio 3

CheckboxPotassium Iodide 50 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxPotassium Bromide 750 mg Capsules (Vet)

Add

Adding

Radio 3

CheckboxPotassium Bromide 350 mg/ml Oral Solution (Vet)

Add

Adding

Radio 3

CheckboxPotassium Bromide 50 mg Capsules (Vet)

Add

Adding

Radio 3

CheckboxPotassium Chloride 6%/Potassium Citrate 6%/Potassium Nitrate 6% Topical Gel

Add

Adding

Radio 3

CheckboxPotassium Bromide 500 mg/ml Oral Solution (Vet)

Add

Adding

Radio 3

CheckboxPotassium Chloride 10 meq Capsules (Vet)

Add

Adding

Radio 3

CheckboxPotassium Bromide 500 mg Capsules (Vet)

Add

Adding

Radio 3

CheckboxPotassium Bromide 375 mg Capsules (Vet)

Add

Adding

Radio 3

CheckboxPotassium Bromide 100 mg/ml Oral Syrup (Vet)

Add

Adding

Radio 3

CheckboxPotassium Chloride 2.68 meq Troche

Add

Adding

Radio 3

CheckboxPotassium 2 meq/15 ml Oral Solution

Add

Adding

Radio 3

CheckboxPotassium Bromide 250 mg Capsules (Vet)

Add

Adding

Radio 3

CheckboxPotassium 14.47 meq/15 ml Oral Solution

Add

Adding

Radio 3

CheckboxPotassium Bromide 600 mg Capsules (Vet)

Add

Adding

Radio 3

CheckboxPotassium Chloride 10% Oral Syrup (Gluten Free)

Add

Adding

Radio 3

CheckboxPotassium Bromide 250 mg/ml Oral Solution (Vet)

Add

Adding

Radio 3

CheckboxPotassium Chloride 5% Oral Syrup

Directions:

QTY:

Refills

1

2

3

4

5

6

7

8

9

10

xPrescriber's Signature:

Date

3

Circle for steps.

Fill out the Pharmacy Name and Fax Number, then fax it to the Pharmacy.

Pharmacy Name

Pharmacy Fax Number

You may need to scale up or down your order form when printing to make it fit the page.

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.