ApothéCure - Creative Custom Compounds
Pharmacy Hours: Mon-Fri 10am to 6pm CT (Closed Sat/Sun)
DFW Local: _ 972-960-6601 _ pharmacistapothecure.com
United States: _ 800-969-6601 _ pharmacistapothecure.com
Canada: _ 800-203-2158 _ intapothecure.com
Worldwide: _ 001-972-960-6601 _ intapothecure.com
 
Celebrating 20 Years of Excellence in Creative Custom Compounds
 
 
 
 

Need answers?

If you have questions, please call us at: 800-969-6601

or email us at:
infoapothecure.com

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ApothéCure, Inc.

Resource Center

ApothéCure would like to share with you the many medical resources we have accumulated over the years.   If you are looking for a physician in your area that uses products compounded by ApothéCure, we have the resources to help you!

 
 

Physician Referral Request Form

Please fill out our convenient "privacy protected" online referral request form below and provide detailed comments about your request.

ApothéCure will NEVER sell, transfer, give out, reveal, spam or allow third parties to access to your personally identifiable information.

PATIENT INFORMATION:
 

FIRST NAME:*

LAST NAME:*

ADDRESS 1:*

ADDRESS 2:

CITY:*

STATE:*

ZIP:*

COUNTRY:

HOME PHONE:*

EMAIL ADDRESS:*
 

DOCTOR INFORMATION:*
 

What type of doctor are you looking for?

I would like confirmation for my referral by:  
 

REFERRAL COMMENTS / SPECIAL INSTRUCTIONS:
 

ENTER COMMENTS/INSTRUCTIONS BELOW:  (be specific)
 
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Last Modified: March 14 2012 08:02:09