Prescriber Forms

Akina Pharmacy Forms

We’ve made prescribing easy to save you and your staff time.

Note: This section is for prescribers only.
Prescription forms can only be completed and transmitted by the prescriber.
Complete the online fillable prescription form, and fax it to Akina Pharmacy. We will immediately contact your patient!

You will need Adobe Reader to edit the form.
 Get it Here 

Windows/Microsoft Edge Browser: PF Editing is not available.  You must use Chrome or Firefox.  Learn more.

Google Chrome: Click  Menu & click Print. Click Change button under Destination and select “Save as PDF”.
Apple/Mac Safari Browser: Click Menu, File, then Print. On the bottom left, select the PDF dropdown icon, and select “Save as PDF”.