Printable Rx Pad

In order to make the referral process easier, we provide a printable version of our RX pad. Print, fill out, and fax to any of our locations:

East Mesa fax: (480) 981-8595

Maricopa fax: (520) 568-2865

Tempe fax: (480) 833-1312

If you have any questions or would like a hard copy RX pad, contact our Tempe office at (480) 833-1005 and ask for Lora.

Printable RX Pad