Direct Dispensing

This duplex script form is mailed to the healthcare provider on the same date that the prescription is shipped via UPS to the patient. The front side provides general instructions for use. Specific instructions for individual conditions may be provided on the reverse side by the healthcare practitioner.

Black and White

Click here to download Script Sheet – A (Front)

Click here to download Script Sheet – B (Back)

Click here to download the Dispense Form

or print through your browser . . .

Reverse Side

For free personalized prescription forms visit our Contact Us page or call 800.554.1501 or fax 770.952.7492.