Verbal Prescription Pad Template


This template for verbal prescriptions contains the most pertinent information you need for documenting Rx’s.

Page 1 contains an actual size (4 to a page) so you can make copies and cut them up.

Page 2 contains a full size template that you can send to a print shop so they can make Rx pads.

Usage Rights and Disclaimer

Each download allows for the copy and use of the form for one pharmacy permit.

NOTE: This form is intended as an aid only and Pharmacy Compliance Specialists, LLC, shall not be held liable for damages resulting from the use or misuse of this product. 

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