Online Prescription Form

Password Notice The following page is exclusive to verified providers, and requires a password from Town & Country Compounding. If you don't have the password yet, get it HERE.

How to send in Rx Order Forms

Medical practitioners can easily fax in this Rx Order Form to Town & Country Compounding.

Fax in printed Rx Order Form

Either fill Rx Order Form digitally, print and fax or print the blank form, write in information and fax.

FAX: 201-447-3253

Would you like to submit your prescription online?

Fill out the prescription form below (not for controlled substances).

Other ways to send Prescriptions

1. Fax or Email

Write a prescription on a prescription pad and fax over to 201-447-3253 OR email to pharmacist@tccompound.com

2. E-Scribe

E-Rx (E-scribe) to “Town & Country Compounding & Consultation.”

*Make sure our address is 535 E Crescent Avenue, Ramsey, NJ 07446

3. Call or Text

Call in or text prescription to
201-447-2020

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