Skip to content

Give us a call 918.578.0031
Choose option 1 for Broken Arrow,
option 2 for Tulsa

Facebook page for NextGenRx Pharmacy Instagram link to NextGenRx page

811 W. New Orleans St., #101
Broken Arrow, OK 74011

NOW OPEN!!
4132 E. 51st St. | Tulsa, OK 74135

811 W. New Orleans St., #101 • Broken Arrow, OK 74011

NOW OPEN!! 4132 E. 51st St. | Tulsa, OK 74135

Home
Price Check
Immune Boost
Medications
Refills
Consultations
Vitality Program
RxAngels
Products
About
Physicians
- New Prescriber Form
Media
Careers
Policies
- Payment Policy
- Informed Consent for Delivery/Shipping
Contact

Informed Consent for Shipping/Delivery of Prescriptions

Name(Required)

First Last

Date of Birth(Required)

MM slash DD slash YYYY

Phone(Required)

Consent(Required)

I agree to the Agreement of Terms.

I have discussed this service with my medical practitioner or his/her representative and/or NextGenRx representative and affirm my desire to utilize NextGenRx for my prescription and be sent directly to me.

I understand that NextGenRx will do everything possible to decrease and minimize the delay of delivery of my prescription order but that there are no guarantees that these measures will be effective at preventing loss or delay of delivery of my medication. I accept the risks and unknowns of having my prescription orders delivered by USPS/UPS/FEDEX/Pharmacy Delivery.

Name

This field is for validation purposes and should be left unchanged.

© 2023 NextGenRx Compounding Pharmacy | All Rights Reserved | Privacy Policy | 811 W. New Orleans St. #101 • Broken Arrow, OK 74011 | Managed by Electric Mustache