Online Prescription Form

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

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