MediScripts Prescription Pads

Questions? Call: (800) 387-3636   

New User

Thank you for choosing MediScripts as your prescription pad provider. We require the below information in order to validate you and create a file in our system. You will be emailed a link to your online account or be contacted by one of our customer service agents within one business day.

Current MediScripts practitioners can login here. If you need a login, you can request one here.

* Indicates required field

Personal Information

First Name *
Last Name *
Title *
Additional Title
Specialty *
NPI Number *
   and/or
DEA Number *
   and/or
State License Number *

Practice Information

Practice or Building Name
Address 1 *
Address 2
City *
State *
Zip Code *
Practice Phone Number *
- -
Practice Fax Number *
- -
Email Address *

Contact Information

Practice Contact Name
Contact Title
Contact Phone Number
- -
Contact Fax Number
- -
Contact Email Address

Other Information

Average number of prescriptions written daily


Comments

As a MediScripts practitioner, I agree to receive special offers, discounts and other promotional information by mail, email and fax.
For more information on our Communications Policy, click here.