Submit your prescription

This submission form is for paper prescriptions only. If you do not have a paper Rx, ask your physician to send it to Stroud Compounding and Wellness Pharmacy in Stroudsburg, PA.

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Name*

First Last

Phone*

Email*

Date of Birth*

Upload Prescription*

Max. file size: 256 MB.

Delivery Address*

Street Address Address Line 2 City State ZIP Code

Additional Instructions

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Comments

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