Western Allergy Services - Electronic RxPad

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Electronic RxPad

For use by doctors, the Online Secure Electronic RxPad lists the full line of Western Allergy Services products, and makes it easy to select formulations.

Use this form to place a new order or to reorder an existing prescription. (Please note for a reorder, you will be asked to provide a Lot Number and a Vial Number.)

Please note that most fields are required. * Some fields are optional.

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Ship To Information
Name:
* Clinic:
Street:
City:
Province:
Postal Code:
Phone Number:

Bill To Information
Name:
* Building:
Street:
City:
Province:
Postal Code:
Phone Number: