HOME MEDICATION CATALOG REFILLS NEW RX ORDER QUOTES PRESS PRINTABLE MATERIALS CONTACT Diamondback Drugs - NEW RX ORDER FORM Prescriptions must be written by a Veterinarian who has physically examined the patient. Fill out the form below, print, sign, and send it to our toll free fax: 1-866-646-2235. If you would like to place your order verbally contact us at the number listed below. If you would like to print out a blank form click here. * Please check all applicable boxes   Date:  Patient Name:  Time:  Species:  Faxed by:  Owner's Name:  Terms:   Ship Patient Ship Clinic   Bill Patient Bill Clinic   Shipping Instructions:   Standard Overnight Saturday Patient/Owners Info (If applicable) Address:     City:   State:   Zip:   Owner's Tel #   (with area code) Clinic Info (If applicable)  Dr.'s Name:    Clinic:   Phone:   (with area code) CC# Exp: Sec Code:       New RX Dispense as Written Substitution Permissable Prescriber's Signature: Diamondback Drugs 7316 East Thomas Road - Scottsdale, Arizona 85251 Telephone: 480-946-2223 - Toll Free: 1-866-646-2223 Fax: 480-946-2235 - Toll Free Fax: 1-866-646-2235 Email: pharmacist@diamondbackdrugs.com Home | Meds Catalog | New Orders | Refills | Press | Printed Materials | Contact