Get Leiter's Compounding Order Form -c Pf Solution 2015-2026

This guide provides comprehensive instructions for successfully completing the Leiter's Compounding Order Form -C PF Solution online. By following these steps, you will ensure that all necessary information is accurately provided for your order.

Follow the steps to accurately fill out the order form.

1. Press the ‘Get Form’ button to access the Leiter's Compounding Order Form online.
2. In the 'Prescriber's Full Name' field, enter the full name of the prescriber placing the order.
3. Provide the prescriber’s NPI# and DEA# in the designated fields. This information is vital for identification.
4. In the 'Faxed By' section, fill in your name or the name of the individual submitting the form.
5. Enter the 'Date Ordered/Faxed,' which is the date you are submitting the form.
6. Select the appropriate shipping method under 'Shipping Information.' You can choose FedEx Overnight on ice or indicate any specific instructions such as Saturday delivery.
7. Complete the shipping section with the name of the facility, shipping address, city, state, and zip code.
8. Provide a phone number where you can be reached, along with the contact name and email for any inquiries.
9. Under the billing information section, fill in the billing name, billing address, city, state, and zip code.
10. Enter your phone number and credit card expiration date along with credit card details or a purchase order number.
11. If applicable, enter your Leiter's customer number, although this step is not required.
12. Check the box if you prefer not to receive updates from Leiter's Compounding via email.
13. Review all information entered for accuracy before submission. Once confirmed, you can save changes, download, print, or share the form as needed.

Complete your documents online to ensure a smooth ordering process.