New Prescription

I have a written prescription from my doctor…

Please do not use the form below if your doctor has provided you with a written prescription. Your doctor may not authorize a prescription over the phone if he/she has already written one out. Simply bring the written prescription order to Jolley’s Compounding Pharmacy to be filled if you’d like to pick it up.

I do not have a written prescription from my doctor…

Please complete the form below if your doctor requests that a pharmacist phone him/her for your new prescription, and has not provided you with a written prescription. We will use the information you provide to contact your doctor for authorization to fill your prescription. You may have your prescription shipped to you, or you may pick it up at your local Jolley’s Compounding Pharmacy.

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