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RX ORDER FORMS

Prescribe Medications through T&C Compounding

Rx ORDER FORMS

T&C Compounding provides the compounded medications your patient needs. We ask that you provide your NPI number to access the Rx Order Forms.

COVID-19

COVID-19 Pre-Procedure Package Rx Order Form

HORMONES

BHRT Rx Order Form

MEN’S HEALTH

Men’s Health Rx Order FormMen’s Urology Rx Order FormErectile Dysfunction

CHRONIC SINUS/ENT

ENT- Biotoxin Illness Rx Order FormENT – Otic Focused Rx Order FormENT – Sinus Irrigation Rx Order Form

DERMATOLOGY

Topical Acne Rx Order FormTopical Psoriasis/Eczema Rx Order FormWARTS RX ORDER FORMTOPICAL UREA FORMULATIONS RX ORDER FORM

HUMAN CHORIONIC GONADOTROPIN (HCG)

Human Chorionic Gonadotropin (HCG) Rx Order Form

ANTI-INFECTIVE

FUNGAL SKIN INFECTIONS WITH INFLAMMATION RX ORDER FORMTOPICAL ANTI-INFECTIVE (BACTERIAL AND FUNGAL) RX ORDER FORM

SEXUAL DYSFUNCTION

Tri-Mix Rx Order FormVaginal Issues Rx Order FormErectile Dysfunction

OPHTHALMIC

Ophthalmic Generic Rx Order FormOphthalmic Anti-Infective Rx Order FormAutologous Serum Eye Drops Rx Order Form

PODIATRY

FOOT AND NAIL INFECTION RX ORDER FORM

PAIN

Low Dose Naltrexone Rx Order Form

WOMEN

BHRT Rx Order FormVaginal Issues Rx Order Form

LOW DOSE NALTREXONE

Low Dose Naltrexone Rx Order Form

GASTROINTESTINAL

Gastrointestinal Rx Order Form

DENTAL

Periogel Rx Order Form

BRAIN

RG3 (Synapsin®) Rx Order Form

WRITING A PRESCRIPTION FOR A COMPOUNDED MEDICATION

Our pharmacists are happy to discuss any medication formulations and answer any questions.

To receive a list of medication formulas to prescribe to your patients, please fill out the following form.

Interested in:
Perio GelCOVID-19Women's HealthMen's HealthSexual HealthBio-Identical Hormone Replacement TherapyCosmeticDermatologyEar, Nose, ThroatHCG Diet ProgramLow Dose NaltrexoneOncologyPainPodiatryScarsSports MedicineWeight LossVeterinary

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