Please download one of the following forms to order by fax. You may complete it and fax it directly to the number on the form. Our pharmacy will process your order within 72 hours, and send to you via the shipping method chosen.
Compounded formulations typically prescribed in the following categories:
Ophthalmic Patient Specific Order Forms
- GoDropless®Order Form
- LessDrops® Topical Order Form
- Other Topical Order Form
- IV Free® Order Form
- Simple Drops® Order Form
- Total Tears®Order Form
- Custom Compound Order Form
Please note: If faxed, the prescription must be sent in by a prescribing practitioner to be considered.