spacer
Do you have any of the following questions?
Are you a physician and you aren’t finding what you are looking for?
Are you having trouble locating a manufactured commercial product that is back ordered or discontinued?
Did you just read about a new treatment, but the medication does not seem to be available?


If any of these questions sound familiar, ask us! Martin Avenue Pharmacy, Inc. can custom compound a medication to meet your patient’s specific needs. When notifying us, please provide as much detail as possible, and we will respond with drug availability, price and delivery time. If you have any printed information, such as journal articles or old package inserts, please inform us so that we can obtain a copy.

Who is eligible for a formulation consultation?
• Physicians
• Veterinarians
• Equine Veterinarians
• Dentists
• Nurse Practitioners
• Clinical Nurse Specialists

Privacy Policy: Martin Avenue Pharmacy, Inc. will not sell, loan, rent or give your email address, mailing address, or phone number to anyone, in keeping with our privacy policy.

Consultation Request Form Download, Click Here. Fax to Martin Avenue Pharmacy at (630) 355-6522

(Note: Questions marked with an asterisk * are required)

*Physician First Name:
*Physician Last Name:
*State License Number:
*Practice:
*State:
*Email:
*Phone:
Fax:

  Drug Information:
 
Commercial Product Name:
Commercial Source:
Commercial Price:
Commercially Available Quantities:

*
Chemical Name (s):
*Active Ingredients w/Strength:
*Size:
Quantity Usually Ordered:
Days Supply:
*Dosage Form:
*Administration Route:
*Drug's Clinical Indication:
Name of Current Supplier:
Flavor (if applicable):
*Additional Information/Directions: