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/ Referral Forms

Referral Forms


ReCept accepts e-prescribing on all medications including Cll prescriptions. Using your local ReCept NPI# under your retail tab in your EMR/HER or standalone e-prescribing application.


As an alternative for hard copy prescriptions, you can fax your prescription form with a front and back copy of your patient’s benefit card to the pharmacy location on your referral form.


Call one of our local ReCept Pharmacy locations.

Xifaxan Connect

Click on the logo above to access the Xifaxan Connect Prescription Enrollment Form.






Dallas/Fort Worth

El Paso


Licensed Prescribers

You now have the opportunity to start your patient’s therapy using our online referral forms. If you are a licensed prescriber, you can begin the prescription process today.


Unsure what pharmacy to select? Please click here, and a sales representative will contact you directly.

To order customize referral forms for your practice or to request additional information, please click here.

Dedicated Account Manager

ReCept values the relationships we maintain with health care providers. For that reason, we have dedicated staff who:

  • Dedicated customer support regarding your new or existing patients.
  • Meet with providers like you.
  • Assist in easing the administrative burden.
  • Help your patients get the medications they need.

Click here to contact your local area representative and we will be in touch within one business day.