Fax Order Form
Triple i offers two subscription levels for our advertiser-supported prescription pad service.
- To subscribe online, click here to register.
- To download a Fax Subscription Form, click here .
Triple i continues to offer the option of purchasing prescription pads on a non-subscription basis. To download a Triple i Fax Order Form, click on the state where your practice is located. Or select your state from the dropdown menu below. If ordering pads for practices in different states, please submit orders separately so we can ensure that the proper signature line is printed for each state.
- Complete the form online by typing in your information.
It is required that you provide the State Medical License number for each practitioner, even if you choose not to print the number on the prescription pads.
- Print the form by choosing File>Print in menu bar.
- Sign form.
- Fax, along with a voided script, to Triple i 1-877-RXPADS1 (1-877-797-2371)
To order Premium Security prescription pads, click here.
To order Memo or Medical Excuse pads, click here.
Questions? Call Customer Service 1-800-969-7237