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.

"*" indicates required fields

Name*
MM slash DD slash YYYY
Max. file size: 256 MB.
Delivery Address*
Privacy & Consent
This field is for validation purposes and should be left unchanged.