The following forms are intended for informational purposes only and do not always constitute a complete prescription to Curexa Pharmacy. Forms are for licensed prescriber use only to assist in the Curexa Pharmacy enrollment process. Faxed prescriptions may only be accepted by licensed prescribing practitioners as required by state prescribing laws. If you have any further questions, please contact us at 855.927.0390.

Form

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Bleeding Disorders

PDF

Dermatology

PDF

Dificid®

PDF

Gastroenterology

PDF

General

PDF

Gentleman's Choice

PDF

Hepatitis C

PDF

HIV

PDF

Hypercholesterolemia

PDF

Multiple Sclerosis

PDF

Naloxone

PDF

Osteoporosis

PDF

Rasuvo® & Oxtrexup™

PDF

Repatha™

PDF

Rheumatology

PDF

RhoGAM® & Rhophylac®

PDF

Santyl®

PDF

Santyl® Home Health Referral

PDF

Sivextro™

PDF

Topical Dermatology

PDF

von Willebrand Disease

PDF