Prescription Pads

Prescription Pads
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Prescription Pads
Large Size scripts (5" x 7") on an 8-1/2" x 11" carrier. Exceeds California Board of Pharmacy & SB151 security requirements. Add up to nine prescribers and/or locations in the imprint area at top of form. Refer to the price list for current pricing and ordering increments.
  • Size: 8-1/2 x 11
  • Paper: Rx Security
  • Ink: Blue & Black

Laser & Ink Jet Compatible Forms

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Laser & Ink Jet Compatible Forms   (PLF)
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Description: Large Size scripts (5" x 7") on an 8-1/2" x 11" carrier. Exceeds California Board of Pharmacy & SB151 security requirements. Add up to nine prescribers and/or locations in the imprint area at top of form. Refer to the price list for current pricing and ordering increments.
Size: 8-1/2 x 11
Paper: Rx Security
Ink: Blue & Black
Form ID: PLF

  1. Enter Quantity
  2. Pricing Matrix:

    No. of
    Forms
    Total
    Price
    100
    $98.60
    500
    $227.00
    1000
    $321.80
    2500
    $642.20
    5000
    $984.00
    10000
    $1,370.00
    Senate Bill 151 Frequently Asked Questions
    All items marked with an asterisk * are required.
  3. *Include Name of Medical Practice on Script?

  4. *Include Type of Medical Practice on Script?

  5. *Fax number on scripts?

  6. *DEA Registration is Required. You May:

  7. Attach DEA Registration:

  8. Additional Prescriber Information for additional prescribers, please include Name, License Number, and Federal Controlled Substance/DEA No.

  9. Additional Location Information for additional locations, please provide Address, City, State, and Zip of each location