Use this form to REORDER PRESCRIPTION PADS: CLICK HERE
For quantities over 100 pads, please call 908-392-4664.
For 100 pads or fewer, follow the instructions below.
Ordering One-part New Jersey Prescription Pads
The first set of directions are for Standard one-part prescription pads which can be ordered online.
But sometimes you need extra fields or other information on your one-part prescription pad — in that case we will handle customized set-up for you. Click here for directions for ordering Customized One-part pads (or Two-part pads or Laser pads.)
Directions for STANDARD one-part prescription pads.
Step 1:
Go to our online portal: click here.
First-time customers can register; return customers can log in.
You will see available options for standard prescription pads. When you select the type of pad you want you’ll enter the information needed to create your prescription pad.
After entering the necessary information, you will be shown a proof of the pad. It will be a bit blurry – this is done intentionally, for security.
Step 2:
When you are satisfied with the layout of the prescription pad you can place your order and check out.
Step 3:
If you are a NEW CUSTOMER, click here to go to Step 3.
All new customers must complete this form required by the state of New Jersey.
Pricing for 1-part pads, no address backer
| Pads | 10 | 20 | 40 | 100 |
| 100 scripts per pad | $100.00 | $138.00 | $230.00 | $469.00 |
Pricing for 1-part with address backer
| Pads | 10 | 20 | 40 | 100 |
| 100 scripts per pad | $140.00 | $210.00 | $332.00 | $715.00 |
Freight is as follows:
- 10 pads $17.00
- 20 pads $19.00
- 40 pads $ 34.00
- 100 pads $56.00
Freight cost will be added directly to the order.
Two-part and laser online ordering will be coming shortly
Ordering Customized One-part, Two-part or Laser prescription forms in New Jersey
For customized one-part, two-part or laser prescription forms, New Jersey requires the following form before we can process the order. With the information provided on the form we will design your prescriptions pads/forms.
Step 1:
Click here for writeable PDF RX Order form.
Once it is filled out and the Doctors have signed it (New Jersey requires live signatures), scan and send to
**To ensure legibility, all parts of the form should be filled out using a keyboard EXCEPT for the handwritten signatures of the Doctors.
Step 2:
A proof will be sent to you via email.
You will need to approve the proof, then we can place the order.
Freight cost will be added at that time.
Step 3:
If you are a NEW CUSTOMER, click here to go to Step 3.
All new customers must complete this Doctor’s signature form required by the state of New Jersey.
For any orders over 100 Pads or 3000 laser sheets call 908-392-4664 for pricing.
Pricing for Customized one-part pads:
will be discussed and finalized before printing.
Pricing for 2-part with no address backer
| Pads | 10 | 20 | 40 | 100 |
| 50 scripts per pad | $138.00 | $214.00 | $269.00 | $585.00 |
Pricing for 2-part with address backer
| Pads | 10 | 20 | 40 | 100 |
| 50 scripts per pad | $198.00 | $247.00 | $356.00 | $835.00 |
Freight is as follows:
- 10 pads $17.00
- 20 pads $19.00
- 40 pads $ 34.00
- 100 pads $56.00
Freight cost will be added directly to the order
Laser Sheets no address backer
| Quantity | 500 | 1000 | 2000 | 3000 |
| Price | $165.00 | $220.00 | $358.00 | $434.00 |
Laser Sheets with address backer
| Quantity | 500 | 1000 | 2000 | 3000 |
| Price | $220.00 | $310.00 | $560.00 | $825.00 |
Freight is as follows:
- 500 Sheets $16.00
- 1000 Sheets $19.00
- 2000 Sheets $ 39.00
- 3000 Sheets $56.00
Freight cost will be added directly to the order.
Step 3:
ALL NEW CUSTOMERS MUST FILL OUT THE DOCTORS SIGNATURE FORM; IT IS REQUIRED BY THE STATE OF NEW JERSEY.
Click here to download the writable PDF Doctor’s Signature form.Once the form is completed and the Doctors sign (New Jersey requires live signatures), scan and email the form to: .
