To complete the form please use a desktop device. Thank you.
Online prescription
- 1. Complete
- 2. Validate
- 3. Print and send OR send by email
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| Complete the form online |
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| Print or send by email |
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| Provide additional info if necessary |
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| Place the prescription in the box with the impressions and models and send |
To fill the RX form save the form on your computer, open it using Adobe Reader, complete the form and click on PRINT or EMAIL US YOUR RX.