Men’s Sexual Health Rx Order Form

Please Note: This is not access to the provider portal, To access the provider portal click here.

How to send in Prescription Order Forms

Medical practitioners can easily send in their Prescription Order Forms to Town & Country Compounding through our Provider Portal.

Controlled substances must be completed electronically.

Men’s Health & Urology Part I
  • Compounded Penile Injections (Tri-Mix)
  • Erectile Dysfunction Treatment Accessories
  • Libido & Orgasm Aids
  • Erectile Dysfunction Sublingual Troches
  • Erectile Dysfunction Capsules / Tablets
Men’s Health & Urology Part II
  • Topical Testosterone
  • Injectable Testosterone
  • Other Therapy Options
  • Custom Orders
Call or Text: 201-447-2020