Referral Forms
E-Prescribe
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.
Fax
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.
Click on the logo above to access the Xifaxan Connect Prescription Enrollment Form.
Birmingham
Dermatology
Supportive Dermatology Products
Gastroenterology
Hematology
Hepatitis C - Preferred Guided
Orthopedic
Osteoporosis
Rheumatology
Transplant
Multiple Sclerosis
Flowood
Dermatology
Supportive Dermatology Products
Gastroenterology
Hematology
Hepatitis C -Preferred Guided
Orthopedic
Osteoporosis
Rheumatology
Transplant
Multiple Sclerosis
Dallas/Fort Worth
Dermatology
Supportive Dermatology Products
Gastroenterology
Hematology
Hepatitis C -Preferred Guided
Orthopedic
Osteoporosis
Rheumatology
Transplant
Multiple Sclerosis
El Paso
Dermatology
Supportive Dermatology Products
Gastroenterology
Hematology
Hepatitis C -Preferred Guided
Orthopedic
Osteoporosis
Rheumatology
Transplant
Multiple Sclerosis
Houston
Dermatology
Supportive Dermatology Products
Gastroenterology
Hematology
Hepatitis C -Preferred Guided
Orthopedic
Osteoporosis
Rheumatology
Transplant
Multiple Sclerosis
San Antonio
Dermatology
Supportive Dermatology Products
Gastroenterology
Hematology
Hepatitis C -Preferred Guided
Orthopedic
Osteoporosis
Rheumatology
Transplant
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.
Support
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.
