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Writing For A Compounded Prescription

For a printable version of  how to write for a compounded prescription, click here

 Please note that all compounds for office use require a written prescription for each individual patient.
Medication will be dispensed in patient specific package with patient specific label.

Rx

Name: ______________________
Date: _______________________

Pt. Phone: ___________________

Compounded Medication
(please indicate it’s a compounded prescription)

Generic name of active ingredient(s) / Strength or Dose (i.e. % or mg)

____________________________________________________

Dosage Form (i.e., Transdermal, suppository, capsule, troche)

_______________________________________________

Quantity _____________________

Sig ____________________________________________________

_______________________________________________________

Doctor name (print): ________________

Doctor phone: ___________________

Doctor: ______________________

Please contact our pharmacy for specific questions regarding formulations: 1.866.883.8868 (toll free)

Check out the photos of where our tote bag has traveled!

Watch Mike Collins R.Ph. and Amy Dwyer R.Ph. , Nutritionist on the PBS, Life After 50 program
Mike Collins R.Ph., FIACP speaks about pain medications
Amy Dwyer R. Ph. Nutritionist speaks about supplements
Mike Collins R.Ph., FIACP speaks about the art of compounding

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PHYSICIAN REFERRAL LIST

 

Keri Topouzian Anti-Aging & Functional Medicine, Naturopathic, Holistic, Alternative and Homeopathic Medicine

Memberships

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Michigan Pharmacists Association

 

 

 

International Academy of Compounding Pharmacists

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*Products not intended to diagnose, treat, cure or prevent any disease. Statements have not been evaluated by the FDA.