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).

Ways to Send in Prescriptions

1. Provider Portal

Our provider portal makes it easy to manage prescriptions.

– Manage Refills
– Adherence Monitoring
– Direct Pharmacy Support
– Reporting

2. Fax or Email

Write a prescription on a prescription pad and fax over to 201-447-3253 OR email to

3. E-Scribe

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

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

4. Call or Text

Call in or text prescription to

5. Fill Out Pre-made Rx Order Forms from Town & Country Compounding

See what your colleagues are prescribing based on specialty

Fill out Town & Country Compounding Rx Order Forms and Fax »

Access to these Rx Forms are exclusively for physicians. Click here to request access

Call or Text: 201-447-2020