Simply download the form, type or print the appropriate information and fax to your local pharmacy.
We encourage you to e-prescribe to make the process easier.
Contact your account manager for customized referral forms.
Please note: This section is for prescribing practitioners only. Patients must bring an original prescription to the pharmacy, and cannot fax these referral forms to Quality Specialty Pharmacy. Faxed prescriptions will only be accepted from a prescribing practitioner.
For best results, download the latest version of Acrobat Reader.
Don't see your specialty or medication?
We accept all prescriptions, feel free to ePrescribe or fax a General Prescription form for any medication you need filled for your patients.
We accept all prescriptions, feel free to ePrescribe or fax a General Prescription form for any medication you need filled for your patients.
