Pharmacy Order Form

Pharmacy Order Form

To our pharmacy colleagues: Please enter your order in the form below. We will contact you as soon as we receive the order to notify you of when it will be prepared and delivered. If you do not currently have a Compounding Agreement with our pharmacy please contact us at (587) 758-0812 and we will set you up.

Online Order Form

Pharmacy Order Form

Diclofenac 10% PLO gel: 

Diclofenac 10% versapro cream: 


Download Order Form