Print a Mail Order Form

To order by mail, please send us:

  • the original written prescription from your physician
  • a completed order form (download here)
  • payment by check, money order or credit card.

Mail the completed order form, written prescription and method of payment to:

PathemaRX
4300 N University Dr #C101
Lauderhill, FL 33351

New prescription orders will not be filled unless we have the completed mail order form and original written prescription.  If your order includes a refill request, we will process and ship the refill immediately.  New orders will be shipped separately.

Please review the frequently asked questions (FAQs) for more information on the order and delivery process.