Telemedicine Inquiry This page is intended for prescribing physicians only. If you are a patient and have questions, please contact an ImprimisRx customer care representative toll-free at (844) 446-6979. Thank you for your interest in setting up your telemedicine account with ImprimisRx in partnership with Doxy.me. Please fill out the information below. If you are an existing or a new ImprimisRx customer, we will set you up and get you ready-to-go within 24 hours. Prescriber Name*Prescriber Name Prescriber First Name Prescriber Last Name Email*Email Address (DO NOT USE THE SAME EMAIL FOR MULTIPLE DOCTORS. AN INDIVIDUAL EMAIL IS NEEDED TO SIGN UP EACH DOCTOR'S ACCOUNT) Specialty*SpecialtySelect OneOphthalmologyOptometryRetinaOtherNPI Number*NPI Number Don't know your NPI Number? Click here to look up your NPI number. Facility Name*Facility Name Facility Address*Facility Address Street Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone Number*Cell Phone NumberFacility Contact NameFacility Contact Name First Name Last Name Are you an existing ImprimisRx customer?*Are you an existing ImprimisRx customer? Yes No I'm not sure What EMR system do you use?What EMR system do you use?
