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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.

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Visit the Tutorials tab to learn more.

First

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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

CheckboxMinoxidil 3% Topical Solution

Add

Adding

Radio 3

CheckboxMinoxidil 2% Topical Gel

Add

Adding

Radio 3

CheckboxMinoxidil 4% Topical Gel

Add

Adding

Radio 3

CheckboxMinoxidil 2%/Tretinoin 0.025%/Finasteride 0.05%/Progesterone 0.05% Topical Solution

Add

Adding

Radio 3

CheckboxMidazolam 25 mg/ml Nasal Spray

Add

Adding

Radio 3

CheckboxMinoxidil 5% Shampoo

Add

Adding

Radio 3

CheckboxMinoxidil 2% Topical Solution

Add

Adding

Radio 3

CheckboxMinoxidil 2.5 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxMinoxidil 2%/Progesterone 0.5%/Estradiol 0.02% Topical Foam

Add

Adding

Radio 3

CheckboxMinoxidil 5% Topical Gel

Add

Adding

Radio 3

CheckboxMinoxidil 3%/Finasteride 0.1% Topical Gel

Add

Adding

Radio 3

CheckboxMinoxidil 0.25 mg Capsules

Add

Adding

Radio 3

CheckboxMinocycline 10 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxMinoxidil 1% Topical Gel

Add

Adding

Radio 3

CheckboxMiconazole Nitrate 100 mg Vaginal Suppository

Add

Adding

Radio 3

CheckboxMiconazole Nitrate 1% Topical Gel (Vet)

Add

Adding

Radio 3

CheckboxMiconazole Nitrate 2%/DMSO Topical Solution

Add

Adding

Radio 3

CheckboxMexiletine HCl 150 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxMiconazole Nitrate 10 mg Troche

Add

Adding

Radio 3

CheckboxMidazolam 2 mg/ml Oral SolutionÂ (Gluten Free)

Add

Adding

Radio 3

CheckboxMexiletine HCl 200 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxMidazolam 2 mg/ml Oral SuspensionÂ (Gluten Free)

Add

Adding

Radio 3

CheckboxMidazolam 5 mg/ml Nasal Spray

Add

Adding

Radio 3

CheckboxMiconazole 2%/Salicylic Acid 2%/Fluocinolone Acetonide 0.025% Topical Shampoo

Add

Adding

Radio 3

CheckboxMiconazole Nitrate 6% Topical Gel

Add

Adding

Radio 3

CheckboxMexiletine HCl 250 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxMiconazole Nitrate 125 mg Capsules

Add

Adding

Radio 3

CheckboxMiconazole Nitrate 2%/Lidocaine HCl 2% Topical Cream

Add

Adding

Radio 3

CheckboxMiconazole 2% Shampoo

Add

Adding

Radio 3

CheckboxMetronidazole 500 mg/Nystatin 100,000 Units Suppository

Add

Adding

Radio 3

CheckboxMidazolam 1 mg/ml Oral SolutionÂ (Gluten Free)

Add

Adding

Radio 3

CheckboxMiconazole Nitrate 100 mg/Lidocaine 2% Vaginal Suppository

Add

Adding

Radio 3

CheckboxMiconazole Nitrate 1%/Metronidazole 2% Topical Cream

Add

Adding

Radio 3

CheckboxMiconazole Nitrate 200 mg Vaginal Suppository

Add

Adding

Radio 3

CheckboxMiconazole Nitrate 250 mg Capsules

Add

Adding

Radio 3

CheckboxMiconazole 2%/Ibuprofen 1%/Tea Tree Oil 1% Topical Cream

Add

Adding

Radio 3

CheckboxMiconazole Nitrate 250 mg Troche

Add

Adding

Radio 3

CheckboxMexiletine HCl 10 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxMiconazole 2%/Nystatin 25,000 Units/Gm Topical Ointment

Add

Adding

Radio 3

CheckboxMiconazole Nitrate 500 mg Vaginal Suppository

Add

Adding

Radio 3

CheckboxMetronidazole 250 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxMetronidazole 0.75%/Ketotifen 0.05% Topical Cream

Add

Adding

Radio 3

CheckboxMetronidazole 500 mg Suppository

Add

Adding

Radio 3

CheckboxMetronidazole 125 mg/ml/Nystatin 25,000 Units/ml Vaginal Cream

Add

Adding

Radio 3

CheckboxMetronidazole 2% Topical Gel

Add

Adding

Radio 3

CheckboxMetronidazole 1%/Niacinamide 4% Topical Cream

Add

Adding

Radio 3

CheckboxMetronidazole 250 mg Suppository

Add

Adding

Radio 3

CheckboxMetronidazole Benzoate 50 mg/ml Oral Suspension (Vet)

Add

Adding

Radio 3

CheckboxMetronidazole 25 mg/ml To 50 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxMetronidazole 4%/Zinc Sulfate 2%/Hydrocortisone 1%/Silver Sulfadiazine 0.5% Topical Cream

Add

Adding

Radio 3

CheckboxMetronidazole 30 mg/0.1 ml Topical Gel Gel (Vet)

Add

Adding

Radio 3

CheckboxMetronidazole 50 mg Capsules

Add

Adding

Radio 3

CheckboxMetoprolol Tartrate 50 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxMetronidazole 1% Topical Solution

Add

Adding

Radio 3

CheckboxMetoprolol Tartrate 100 mg Slow Release Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxMetronidazole 2%/Niacinamide 2% Topical Gel

Add

Adding

Radio 3

CheckboxMetronidazole 10% Rectal Gel

Add

Adding

Radio 3

CheckboxMetoprolol Tartrate 50 mg Slow Release Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxMetronidazole 8.3 mg/ml Saline Enema

Add

Adding

Radio 3

CheckboxMetronidazole 2%/Niacinamide 4% Topical Gel

Add

Adding

Radio 3

CheckboxMetoprolol Tartrate 100 mg/Hydrochlorothiazide 25 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxMetronidazole 500 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxMetoprolol Tartrate 100 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxMetronidazole 1%/Niacinamide 4% Topical Gel

Add

Adding

Radio 3

CheckboxMetronidazole 0.75%/Neomycin 0.7% Topical Solution

Add

Adding

Radio 3

CheckboxMetoprolol Tartrate 25 mg Slow Release Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxMetoprolol Tartrate 100 mg/Hydrochlorothiazide 50 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxMetoclopramide 100 mg/ml Nasal Solution

Add

Adding

Radio 3

CheckboxMetoclopramide 5 mg Troche

Add

Adding

Radio 3

CheckboxMethyltestosterone 25 mgÂ Troche

Add

Adding

Radio 3

CheckboxMethylphenidate HCl 30 mg Slow Release CapsulesÂ (Gluten Free)

Add

Adding

Radio 3

CheckboxMetoclopramide 2 mg/0.1 ml Topical Cream (Vet)

Add

Adding

Radio 3

CheckboxMethyltestosterone 10 mgÂ Troche

Add

Adding

Radio 3

CheckboxMethylprednisolone Acetate 40 mg Rectal Enema

Add

Adding

Radio 3

CheckboxMethyltestosterone 10 mg CapsulesÂ (Gluten Free)

Add

Adding

Radio 3

CheckboxMethylphenidate HCl 60 mg Slow Release CapsulesÂ (Gluten Free)

Add

Adding

Radio 3

CheckboxMethyltestosterone 15 mg Capsules

Add

Adding

Radio 3

CheckboxMethylprednisolone Acetate 1%/Neomycin 0.35% Topical Ointment

Add

Adding

Radio 3

CheckboxMetoclopramide 1 mg/ml Oral Solution (Gluten Free/Flavored)

Add

Adding

Radio 3

CheckboxMetoprolol Tartrate 25 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxMetoclopramide 10 mg Troche

Add

Adding

Radio 3

CheckboxMetoclopramide 25 mg Suppository

Add

Adding

Radio 3

CheckboxMethyltestosterone 5 mgÂ Troche

Add

Adding

Radio 3

CheckboxMetoprolol Tartrate 12.5 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxMethylprednisolone 4 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxMethyltestosterone 5 mg Capsules

Add

Adding

Radio 3

CheckboxMethyltestosterone 1 mgÂ Troche

Add

Adding

Radio 3

CheckboxMetoprolol Tartrate 1 mg/ml To 10 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxMetoclopramide 20 mg/Dexamethasone 10 mg/Diphenhydramine HCl 50 mg Suppository

Add

Adding

Radio 3

CheckboxMetoprolol Tartrate 12.5 mg Slow Release Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxMethyltestosterone 20 mg Capsules

Add

Adding

Radio 3

CheckboxMethyltestosterone 2 mgÂ Troche

Add

Adding

Radio 3

CheckboxMethimazole 5%/Tranexamic Acid 5%/Kojic Acid 5%/Niacinamide 5%/Salicylic Acid 1% Topical Gel

Add

Adding

Radio 3

CheckboxMethylcobalamin 2 mg/ml Sublingual Suspension

Add

Adding

Radio 3

CheckboxMethylphenidate HCl 5 mg Slow Release CapsulesÂ (Gluten Free)

Add

Adding

Radio 3

CheckboxMethscopolamine Bromide 0.5 mg Troche

Add

Adding

Radio 3

CheckboxMethotrexate 0.5 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxMethyl Salicylate 60% Compound Topical Gel

Add

Adding

Radio 3

CheckboxMethylcobalamin 1 mg/ml Nasal Spray

Add

Adding

Radio 3

CheckboxMethotrexate 0.01% Topical Cream

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!

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