Customize Your Pain Compound | Davis Island's Pharmacy and Compounding Lab | Tampa
 

Customize Your Pain Compound

< Pain Management Compounding

 

 

Fill out the following form to request a customized pain compound quote from our lab

 

  Your information is encrypted and secured for your protection.

 


Compound Name/ Active Ingredients (required):

Customize Pain Ingredients (check from below):


Anti-inflammatories:

Diclofenac SodiumKetoprofenPiroxicamIbuprofenFlurbiprofenMeloxicamIndomethacin

Muscle Relaxants:

CyclobenzaprineBaclofenGuafenasinOrphenadrineMagnesium Cl

Anesthetics:

LidocainePrilocaineKetamineTetracaineBupivacaine

Vasodilators:

NifedipineVerapamil

Neuropathy Agents:

AmitriptylineGabapentinClonidineImipramine

Misc:

MentholCapsaicinCamphorMethol

Additional Ingredients

Form

Strength (based on form)

Species:

Day's Supply:

This Medication Requires a Prescription

To fulfill your order, we will require a prescription from the Prescriber. We will only compound and dispense upon receipt of a valid patient specific prescription. After making a selection, please provide the relevant information below. If you do not yet have a doctor, leave the relevant fields blank: we're happy to make a referral.


I am a...

How will we be receiving the prescription?

Pharmacy Fax: (813) 254-8396

(to provide the prescriber)

Other pharmacy name and number (if requesting Rx Transfer):


Contact Information


Contact Name:

Contact Email: (required)

Cell Phone (required):

Office Number:

Other Phone:

Delivery Options:

Notes: Notes for Pharmacy, Your Address, Alternative Compound Requirements, Etc.

Opt me out of receiving pharmacy communications


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Looking for a non-pain related compound? Make a more tailored compound quote request here >>