Follow the steps to successfully complete the order form.

1. Press the ‘Get Form’ button to obtain the form and access it in your chosen online platform.
2. Enter the date on which the order is being placed in the designated field.
3. Fill in the physician's name accurately to identify the prescribing professional.
4. Input the facility name where the prescription will be processed.
5. Provide the physician's DEA number in the appropriate field to comply with regulatory requirements.
6. Enter the shipping address where the medication should be delivered, ensuring all details are correct.
7. Complete the billing address section, which may differ from the shipping address.
8. Fill in the city, state, and zip code for both the shipping and billing addresses.
9. Provide a telephone number for contact purposes.
10. Include the fax number where the order should be sent for processing.
11. Add the physician's signature to validate the order and indicate approval.
12. Indicate the number of refills authorized for the prescribed medication.
13. In the patient section, enter the patient’s name and date of birth to associate the order with the correct individual.
14. Fill in the patient’s address along with their city, state, and zip code accurately.
15. Provide a contact telephone number for the patient for any necessary follow-up.
16. List any known allergies the patient may have to avoid adverse reactions.
17. Select the desired product from the options provided, indicating the strength and package size.
18. Specify the quantity of the selected product that is required.
19. Once all fields are completed, save the changes made to the form and prepare for the next step.
20. Download, print, or share the finalized form as needed, and fax it to the designated number.

Complete and submit your order form online for efficient pharmacy services.