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Prescription Pad

Doctors Prescription Form

To be filled by registered Doctors only.

    Patient Details:

    Physician's Details:

    ℞ - Medical Prescription

    All the below compositions can be altered as per physician's recommendations.

    ARTHRITIS | JOINT PAIN | INFLAMMATION

    Mix in appropriate base

    NEUROPATHIC PAIN | MUSCLE SPASM | LOWER BACK PAIN

    Dispense as:

    Mix in appropriate base

    PLANTAR FASCITIS

    Mix in appropriate base

    ANAL FISSURES / HEMMOR RH OIDS

    Dispense as:

    Mix in appropriate base

    NIPPLE OINTMENT

    Mix in appropriate base

    WARTS

    Mix in appropriate base

    FACIAL SPOTS

    Mix in appropriate base

    NAIL FUNGUS

    Mix in appropriate base

    MAGIC MOUTHWASH

    Mix in appropriate base

    OR CHOOSE THESE INGREDIENTS TO MAKE CUSTOM FORMULA (Please indicate the quantity required)

    PEDIATRICS

    Mix in appropriate base

    Fields marked with * are mandatory.

    Notify Your Doctor about Prescription Transfer

    Once you’ve chosen to switch to a new pharmacy, let your doctor know. This will eliminate any confusion for future refills or updates on current prescriptions at your pharmacy.

    Lifecare Rx Pharmacy Inc

    Pharmacy Timings

    In Partnership with

    Pharmacy Accreditation

    Accreditation Number: 308045
    Designated Manager: Jenny Cherian, R.Ph.