Why Order Rx Pads by Fax / Mail?

Our online ordering system can accommodate a number of different tamper resistant prescription pad order preferences, but there are also many conditions that are more suitable to order Rx pads by fax or mail. If you answer yes to any of the following questions, please click on your preferred product state link further down the page to download an order form.

  • Do I need more than one provider on my tamper proof prescription pads?
  • Do I have more than one address to include on my order for Rx pads?
  • Do I prefer a horizontal (landscape) format?
  • Do I want a custom layout that resembles our previous scripts?
  • Would I like my prescriptions to be sequentially numbered? (For sequentially numbered scripts, please call us for the order form.)
  • Do I need to pay for my Rx pad order with a check?

If you need assistance determining whether you should download an order form, or order online, or if you are not sure which order form best suits your needs, please call us at 1-800-510-1050 and we’d be happy to help.

How to Order Rx Pads by Fax / Mail

To order Rx pads by fax/mail from us:

  • Decide which product you need- secure tamper resistant Rx pads, HologramRx prescription pads, or tamper resistant EMR prescription paper (For security reasons, the white, second sheet of our two-part, carbonless copy script is completely blank and only transfers what is written on the script. No other information is preprinted or will appear on the second sheet)
  • Click on your state-specific link listed below, within your product category, to download your order form
  • Print out the prescription pad order form
  • Fill out the order form including credit card information. If you prefer to pay by check, please mail your completed order form with check.
  • Attach a voided copy of your current script* to the order.
  • Fax or Mail your completed order. Our fax number is 800-500-3060 and our mailing address is 983 12th St. Vero Beach, FL 32960.

It’s that simple. And, in just days, you will be writing your secure prescriptions with the same peace of mind that all of our clients have.



Order Rx Pads by Fax - Tamper Resistant Prescription Pads

To order sequentially-numbered scripts, please contact us for an order form by calling 800-510-1050 or emailing cust_serv@nationalrxsecurity.com. If emailing, please state that you would like the sequentially-numbered order form and reference which state you need them for.


Order Rx Pads by Fax - HologramRx Pads


Tamper Resistant Rx Paper (EMR)

Order Rx Pads by Fax - Tamper Resistant EMR Paper


Our Rx pads meet and exceed ALL Federal and State regulations, including those for Medicare/Medicaid. Our tamper resistant Rx is compliant with increased security requirements in Washington, Florida, Wyoming, as well as all other states and Puerto Rico.*

For custom layout design, please contact us at 1-800-510-1050

* We ask that you send a voided script to insure that we receive the complete information for your prescription pad order. We are proud of our 99% accuracy, and this is one way that we achieve that standard.

* Available in all states except DE, IN, KY, NJ and NY.

** Available in all states except CA, DE, IN, KY, NJ, NY and WA.

*** Available in all states except DE, KY, IN, NJ, NY and WA.