California Security Prescription Pad, 8 doctors, 4"x5", pocket-size

Customize this item in 3 simple steps:
1. Enter the appropriate data
2. Check your customized PDF proof
3. Order the item

It's that easy!
click to enlarge
Lab coat size
8 physicians, up to 3 prescriptions
Each 4"x5" pad has 50 two part sets (original and duplicate) and is bound with a wrap-around cover.
Minimum order quantity is 5 pads
Pricing for sample quantities:
Your price will be calculated after quantity is entered.
5 qty $70.00
10 qty $110.00
20 qty $190.00
50 qty $400.00
100 qty $700.00
Step 1: Enter Your Custom Information
Please enter the information that you would like to appear on your prescription pad.
Please carefully check the accuracy of all the information on your PDF proof.
Medical Group Name
Street Address
City State Zip
Phone
Website or other (optional)
Doctor 1 Firstname Lastname
Doctor 1 License Category (MD,DDS etc)
Doctor 1 Practice (optional)
Doctor 1 CA License number
Doctor 1 DEA number
Doctor 1 NPI number (optional)
Doctor 2 Firstname Lastname
Doctor 2 License Category (MD,DDS,etc.)
Doctor 2 Practice (optional)
Doctor 2 CA License number
Doctor 2 DEA number
Doctor 2 NPI number (optional)
Doctor 3 FIrstname Lastname
Doctor 3 License Category (MD,DDS, etc.)
Doctor 3 Practice (optional)
Doctor 3 CA License number
Doctor 3 DEA number
Doctor 3 NPI number (optional)
Doctor 4 Firstname Lastname
Doctor 4 License Category (MD,DDS,etc.)
Doctor 4 Practice (optional)
Doctor 4 CA License number
Doctor 4 DEA number
Doctor 4 NPI number (optional)
Doctor 5 Firstname Lastname
Doctor 5 License Category (MD,DDS,etc.)
Doctor 5 Practice (optional)
Doctor 5 CA License number
Doctor 5 DEA number
Doctor 5 NPI number (optional)
Doctor 6 Firstname Lastname
Doctor 6 License Category (MD,DDS,etc.)
Doctor 6 Practice (optional)
Doctor 6 CA License number
Doctor 6 DEA number
Doctor 6 NPI number (optional)
Doctor 7 Firstname Lastname
Doctor 7 License Category (MD,DDS,etc.)
Doctor 7 Practice (optional)
Doctor 7 CA Licence number
Doctor 7 DEA number
Doctor 7 NPI number (optional)
Doctor 8 Firstname Lastname
Doctor 8 License Category (MD,DDS,etc)
Doctor 8 Practice (optional)
Doctor 8 CA License number
Doctor 8 DEA number
Doctor 8 NPI number (optional)
Step 2: Check Your PDF Proof
(No PDF Proof available, please complete Step 1)
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