NEW PRESCRIPTION ORDER FORM

Ketamine 10 mg Base A Troche

Atropine 0.01% Ophthalmic Drops

Atropine 0.05% Ophthalmic Drops

Atropine 0.02% Ophthalmic Drops

Estriol 1 mg/Gm Slow Release Capsules Size #1

Estradiol 1 mg/Gm Slow Release Capsules Size #1

Estriol/Estradiol [80%/20%] 1 mg/Gm Slow Release Capsules #1

Estriol/Estradiol/Estrone [80%/10%/10%] 1 mg/Gm Slow Release Capsules #1

Estriol/Estradiol/Estrone [80%/10%/10%] 1 mg/Gm Topical Gel

Clomiphene Citrate 25mg Capsules

Testosterone 0.25ml to 1ml Sublingual Drops

Testosterone 0.25ml to 1ml Sublingual Drops

Gabapentin 300 mg / Ketamine HCl 50 mg / Lidocaine 30 mg / Prilocaine 30 mg Wound Care Capsules Size #00

Morphine Sulfate 1 mg/mL Topical Gel

Misoprostol 0.0024% / Phenytoin 5% / Gentamicin 0.2% Topical Gel

Arginine HCl 1% / Aloe Vera 0.2% / Misoprostol 0.0024% / Naltrexone HCl 1% / Phenytoin 2% Topical Gel

Beta Glucan 0.5%/Naltrexone HCl 0.5% Topical Spray

Aloe Vera 0.2% / Arginine HCl 1% / Misoprostol 0.0024% / Naltrexone HCl 1% Topical Gel

Morphine Sulfate 1% Spira-Wash™ Gel

Phenytoin 5%/Naltrexone HCl 1% Topical Gel

Misoprostol 0.0024% / Phenytoin 5% / Metronidazole 2% Topical Gel

Gentamicin 1 mg/Gm / Clindamycin 1 mg/Gm / Polymyxin B 2,000 U/Gm Spira-Wash™ Gel

Levofloxacin 2% / Mupirocin 4% / Itraconazole 1% Spira-Wash™ Gel

Misoprostol 0.0024% / Ciprofloxacin HCl 2% Spira-Wash™ Gel

Misoprostol 0.0024% / Metronidazole 2% / Lidocaine HCl 2% Spira-Wash™ Gel

Mupirocin 5% Spira-Wash™ Gel

Vancomycin 5% / Mupirocin 5% Spira-Wash™ Gel

Metronidazole 4% / Hydrocortisone 1% / Zinc Sulfate 2% / Silver Sulfadiazine 1% Spira-Wash™ Gel

Tobramycin 5% / Mupirocin 5% / Itraconazole 2% Spira-Wash™ Gel

Misoprostol 0.0024% / Phenytoin 5% / Gentamicin 0.2% Spira-Wash™ Gel

Ketoprofen 2% / Lidocaine 2% / Misoprostol 0.0024% / Phenytoin 2% / Aloe Vera 0.2% Spira-Wash™ Gel

Aloe Vera / Vitamin E / Collagen / Allantoin / Lanolin Topical Cream

Phenytoin Sodium 2% / Nifedipine 5% / Tranilast 1% / Misoprostol 0.0024% Topical Gel

Collagenase 350 U/Gm / Hyaluronidase 250 U/Gm Compound Topical Gel

Phenytoin 5% / Misoprostol 0.0024% Spira-Wash™ Gel

Phenytoin 5% / Misoprostol 0.0024% / Nifedipine 2% Spira-Wash™ Gel

Doxycycline 20 mg / Phenytoin 20 mg / Misoprostol 0.024 mg / Lidocaine HCl 10 mg Wound Care Capsules Size #1

Phenytoin 2% / Misoprostol 0.0024% / Lidocaine 2% / Bupivacaine HCl 0.2% / Diphenhydramine HCl 1% / Aloe Vera 0.2% Polyox Bandage

Phenytoin 5% / Misoprostol 0.0024% / Arginine HCl 1% / Sodium Hyaluronate 0.5% Spira-Wash™ Gel

Phenytoin 5% / Misoprostol 0.0024% / Arginine HCl 1% Spira-Wash™ Gel

Misoprostol 0.0024% / Phenytoin 2% / Beta Glucan 0.5% Topical Gel

Allantoin 2% / Vitamin D3 1000 IU/Gm / Aloe Vera 0.5% Spira-Wash™ Gel

Silver Sulfadiazine 1% Topical Gel

Collagenase 250 U/Gm Topical Ointment

Beta Glucan 0.5% / Naltrexone HCl 0.5% Topical Spray

Pyridoxine HCl 10 mg / Ginger Oral Effervescent

Aloe Vera 0.2% / Arginine HCl 1% / Misoprostol 0.0024% / Naltrexone HCl 1% Topical Gel

Ketoprofen 2% / Lidocaine 2% / Misoprostol 0.0024% / Phenytoin 2% / Aloe Vera 0.2% Topical Gel

Aloe Vera / Allantoin / Glycosaminoglycans Spira-Wash™ Gel

Collagenase 250 U/Gm Spira-Wash™ Gel

Doxylamine Succinate 10 mg / Pyridoxine HCl 10 mg Capsules Size #1

Pramoxine HCl 1% / Zinc Oxide 12.5% / Lidocaine HCl 5% Rectal Gel

Ondansetron 4 mg/0.1 mL Topical Lipoderm

Ondansetron 20 mg/mL Topical Gel

Ondansetron 8 mg Oral Effervescent

Collagen / Panthenol/Glycolic Acid 5% (W/W) / Sodium Pyrrolidone Carboxylate / Shea Butter / Wheat Germ Oil / Emu Oil Topical Cream

Lidocaine 2% / Hydrocortisone 1% Base MBK™ / Wax / MucoLox™ Suppository

Lidocaine 2% / Hydrocortisone 1% Base MBK™ / Wax Suppository

Doxylamine Succinate 10 mg / Pyridoxine HCl 10 mg Base MBK™ Suppository

Promethazine HCl 12.5 mg/Gm to 25 mg/Gm Topical Lipoderm

Tretinoin 0.025% / Palmitoyl Pentapeptide / Glycosaminoglycans Topical Gel

Praziquantel 3%/Azelastine HCl 0.1% Topical Gel

Niacinamide 5% / Biotin 0.2% / Glyosaminoglycans / Dimethyl Sulfone Topical Cream

Palmitoyl Pentapeptide Topical Gel

Brimonidine Tartrate 0.5% Topical Gel

Topiramate 2.5%/Aloe Vera 0.5% Topical Gel

Nicotinamide Adenine Dinucleotide Na2 Reduced 1% Topical Ointment

Oxymetazoline HCl 0.06% Topical Cream

Azelaic Acid 15%/Metronidazole 1.2% Topical Gel

Hydroquinone 5% / Glycolic Acid 2.5% / Ascorbic Acid 1% / Fluticasone Propionate 1% Topical Gel

Ketoprofen 10% / Cyclobenzaprine HCl 2% Topical Lipoderm

Niacinamide 4%/Metronidazole 1% Topical Cream

Ketamine HCl 30 mg / Diazepam 1 mg / Lidocaine HCl 30 mg Base MBK™ Vaginal Suppository

Ketoprofen 10% Topical Lipoderm

Ketamine HCl 2.5%/Gabapentin 6%/Lidocaine HCl 2% Vaginal Gel

Ketamine HCl 0.5%/Diazepam 1%/Baclofen 2% Vaginal Gel

Ibuprofen 20% Topical Lipoderm

Diazepam 10 mg/Gm Rectal Gel

Diazepam 5 mg Base MBK™ Suppository

Ibuprofen 600 mg Base MBK™ Suppository

Metformin HCl 10% Vaginal Gel

Imiquimod 6 mg Base MBK™ Suppository

Metformin HCl 10% Topical Lipoderm

Imiquimod 0.5% Vaginal Gel

Diazepam 10 mg/Gm Vaginal Gel

Progesterone 10% Vaginal Gel

Metformin HCl 10% Topical Gel

Progesterone 100 mg Base MBK™ Suppository

Metformin HCl 5% / Spironolactone 5% / Progesterone 1% Topical Gel

Progesterone 10% Vaginal Gel

Tacrolimus 0.03% Vaginal Gel

Deoxy-D-Glucose (2) 0.2% / Acyclovir 5% / Imiquimod 2.5% / Tea Tree Oil 2.5% Vaginal Gel

Boric Acid 600 mg Base MBK™ / MucoLox™ Vaginal Suppository

Amphotericin B 50 mg Base MBK™ Vaginal Suppository

Acyclovir 5% / Lidocaine HCl 5% / Deoxy-D-Glucose (2) 2% Vaginal Gel

Clobetasol Propionate 0.05% Topical/Vaginal Gel

Flucytosine 15% Vaginal Cream

Naltrexone HCl 0.5% Vaginal Gel

Ketotifen 0.4% Vaginal Gel

Fluorouracil 5% Topical Gel