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Prescription lab starts a Osteoporosis Support Group through The National Osteoporosis Foundation more»

Prescription Lab brings on new Pharmacist, launches Nutraceutical Consultation Practice more»

Dana Kurland, R.Ph launches Prescription Lab's Osteoporosis Practice more»

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Physician: Patient Referral Form

As you work hard to provide your patients treatments that can nurse them back to health, PLCP can partner with you to help your patients heal faster. With that goal in mind we have set up a number of consultation services that can complement your treatment such as Chronic Pain Management and Nutritional Consultations. If you wish to refer any of your patients to us, please feel free to use the form below to do so. Our professionals will get in touch with your patient right away. We will also make sure to contact you to keep you informed or to take your input.

Note: fields marked with an asterisk (*) are required fields.
Physician Detail
* Physician Name:
* Address:
* Phone:
* Email:
* Type of Practice :

Dear Pharmacist,

I would like to refer my patient to "the LAB" for a health consultation. The patient’s details are below.

Regards,
Patient Details
*
 Patient Name:
  Gender:
*
 Address:
* Phone
* Email:
 

Medical Condition/s:
 

Type of consultation to which patient is being referred:

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  Special instructions to the pharmacist :

(Type the 5 alphanumeric figures on the left image.)
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©January 7, 2008 Prescription Lab Compounding Pharmacy unless otherwise stated. All rights reserved. No portion of this page or any part of this website many be reproduced for commercial purposes, or appear on any other website than www.rxlab.com without the express written permission of Prescription Lab Compounding Pharmacy, its associates and content providers.

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