California Pocket Prescription Pad (Duplicate) - 1 Name

Customize this item in 3 simple steps:
1. Enter the appropriate data
2. Check your customized PDF proof
3. Order the item

It's that easy!
click to enlarge
Lab Coat size
50 two part sets (original and duplicate) per pad 4 x 5
Bound with a wrap-around cover

The security features of the Lab Coat form
Preprint prescriber informatiom
Security paper is carbonless and perforated for ease of use
Batch/Lot numbers
Reverse Rx disappears when copied to remove background tint
Six check boxes to indicate quantity restriction
Refill restrictions
Do not substitute restriction requiring initial
Single drug Prescription Form statement
Void appears when copied or scanned
Thermochromatic ink will disappear when rubbed
Microprint lines will become unreadable when copied or scanned
California Security Prescription watermark will appear when viewed at an angle
Minimum order quantity is 10 pads
100 qty and over $8.00 each
50 to 99 qty $9.00 each
20 to 49 qty $10.00 each
10 to 19 qty $12.00 each
Step 1: Enter Your Custom Information
Please enter the information that you would like to appear on your prescription pad.
Please carefully check the accuracy of all the information on your PDF proof.
Name
Practice
License #
DEA #
Medical Group Name
Address
City, State, Zip
Phone
Email
Step 2: Check Your PDF Proof
(No PDF Proof available, please complete Step 1)
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