Patient Fax Form Request Letter

Request the MediVera fax forms your prescriber needs to send a compounded prescription to our pharmacy. Choose the forms that match your treatment (hormone replacement therapy, dermatology, men's health, weight management, or women's health), and we'll send them to the email address you provide. MediVera Compounding Pharmacy™ is dual PCAB-accredited in both sterile and non-sterile compounding, licensed in 49 states and growing, and most compounds ship within 48 hours of patient confirmation.