Generic-Pharmacy.com
Low cost generic drug alternatives for your prescription medications

Fax order forms for
Generic Pharmacy Prescriptions

There are forms to send to Pharmacy Can to place your order. The forms are available in two ways:

• as four separate forms
• as one package in an Adobe PDF file
  

Printing the individual fax forms

1. Click on the links to open each form. Click on the print button on your browser to print

Form 1- Basic Information
Form 2- Medical History
Form 3- Prescription Request Form
Form 4- Release Form

2. Fill in the forms and fax to us at:

1-800-640-5553

Downloading and printing the fax forms package

1. Click here to download the Generic Pharmacy Fax Form package.
2. Click on the print button on the Adobe Acrobat toolbar to print the forms as a package.

3. Fill in the forms completely and fax them to us at:

1-800-640-5553

(Requires Adobe Acrobat- click here to download Adobe Acrobat if needed)

Need Help? Give us a call at
1-800-640-2221
and we will get you started today.