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Maine Identification Signature Form

All prescription pad/blank stock orders from the state of Maine must be accompanied by a signature, date and printed name of the authorized licensed medical prescriber. Please fill out the form below. You may also click here to download the signature form.

Please Complete This Signature Form:

Prescriber First Name:

Prescriber Last Name:

Prescriber Email:

Order Number:

Are you the prescriber?

COVID-19 SERVICE ANNOUNCEMENT TO CUSTOMERS

As of today we remain open for business and are receiving, producing and shipping orders. We are taking all of the necessary precautions for our customers, and employees as we operate during this challenging time.

Please plan as best you can for someone to accept shipments at the address provided for your order. To reduce the possibility of delay, please communicate any concerns of delivery to customer service.

Pick-up order service at our office is not available at this time, all orders must be shipped by one of the available services at checkout.