| # | Order ID | Form | Name of Customer | Address | Status |
|---|---|---|---|---|---|
| 1 |
GO-69530a8460aac495172351
12/29/2025 06:11 |
rbcmedical.my.canva.site/rbc-medical | Kristin, Smith | 6 Athol Street Islip Terrace, NY - 11752 | awaiting_shipment |
| 2 |
GO-695307fa19694750999892
12/29/2025 06:00 |
facialaestheticsinc.com | Caitlin Bump | 7447 East Berry Avenue, Suite 160 Greenwood Village, Colorado - 80111 | awaiting_shipment |
| 3 |
GO-6952f1de336bf644383211
12/29/2025 04:25 |
julietaylormd.com | Kay Donmyer | 20530 Aetna St Woodland Hills, CA - 91367 | awaiting_shipment |
| 4 |
GO-6952ed97068bc885771447
12/29/2025 04:07 |
PharmacyChiefs.com | JEFFREY WEISS | 842 Clifton Ave Suite 4 Clifton, New Jersey - 07013 | awaiting_shipment |
| 5 |
GO-6952e8d4dbab1148447533
12/29/2025 03:47 |
avalonaaw.com | LEIF CERVANTES DE REINSTEIN | 256 S WILTON PL LOS ANGELES, CA - 90004 | awaiting_shipment |
| 6 |
GO-6952e6c9a4180161545477
12/29/2025 03:38 |
PharmacyChiefs.com | JAIME MCNITT | 7054 Timbercrest Way Castle Pines, Colorado - 80108 | awaiting_shipment |
| 7 |
GO-6952e6bc9e4dd654262823
12/29/2025 03:38 |
www.evolvehealthks.com | Kristin Loyd | 2118 N. TYLER RD SUITE 102 WICHITA, Kansas - 67212 | awaiting_shipment |
| 8 |
GO-6952dcf93f0e6918000038
12/29/2025 02:56 |
julietaylormd.com | Veronica Vasquez | 3604 Fairmont Ln Oxnard, CA - 93036 | awaiting_shipment |
| 9 |
GO-6952dc77b0f0f329619029
12/29/2025 02:54 |
PharmacyChiefs.com | Bryan Combs | 338 Fox Lair Blvd Fisherville, Alabama - 40023 | awaiting_shipment |
| 10 |
GO-6952d1f5d0dcb692174488
12/29/2025 02:09 |
body4ever.com | Dennis McCracken | 3317 S Higley Rd #100 Gilert, Arizona - 85295 | awaiting_shipment |
| # | Order ID | Form | Name of Customer | Address | Status |
|---|
| # | Products | SKU | Title | Qty | Price |
|---|
| Patient Name (First, Last) |
SEX |
|
||||
| DOB | Cell Phone | |||||
| Shipping Address | ||||||
| Required Patient Information (Fill out or attach demographics with fax) | |
| Allergies (if none, must write none) |
|
| Current Medications (if none, must write none) |
|
| Driver's License # | |
|
|
|
| Facility Name | Facility Phone | ||
| Facility Address | |||
* If Provider is a NP/PA a Supervising Provider is required for a Controlled Substance (or a Standing Order must be on file) *
| Doctor Name Goes Here | |
|---|---|
| Docotors' Notes Content Here | Edit |
| # | Order # | Card No. | Amount | Discount Code Discount Type Discount Amount |
Invoice | Invoice Created |
Is Paid | Is Refunded | Payment Status |
|---|
| # | Order # | Prescription Order No. |
Name | Medication | Refill No | Days Supply | Refills | Order Status |
Canceled At |
Tracking No. |
Shipping Provider |
Date Delivered |
|---|
| Patient Name (First, Last) |
SEX |
|
||||
| DOB | Cell Phone | |||||
| Address | ||||||
| Required Patient Information (Fill out or attach demographics with fax) | |
| Allergies (if none, must write none) |
|
| Current Medications (if none, must write none) |
|
| Driver’s License # | |
|
|
|
| Facility Name | Facility Phone | ||
| Facility Address | |||
* If Provider is a NP/PA a Supervising Provider is required for a Controlled Substance (or a Standing Order must be on file) *