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| Placing your online prescription information with
American Drug Club Direct Doctor |
Placing new prescription orders with American Drug Club Direct Doctor
Ordering prescription drugs from American Drug Club Direct Doctor is fast and easy, and we want to ensure that it is as simple as we say it is. We require a faxed in prescription for your
patient's prescribed medication, along with the completed Order
Form to place an order for prescription drugs.
Once you have completed the Order Form please attach the original prescription and fax the documents to our toll free fax number: 1-866-672-8283.
This will complete the order for prescription drugs.
Fax Forms Directions
Physician Information:
Please list the Physician Information including the DEA # and License information.
Prescription Medication Information:
Please list the Prescription Information including the Strength, Quantity, etc...
Sending Your Information:
Once you have completed the Order Form please attach the original prescription and fax the documents to our toll free fax number: 1-866-672-8283
Please Note: The physician is to fill out all required areas of this form. The Credit Card information is generally that of the patient. All orders will be shipped to your office "care of" the patient designated in the Credit Card information.
 The Order Form
(Standard .html version)
The Order Form
(.pdf version) 
The pages will open in a new window in printer friendly pages.
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