COMPOUNDING | KCP

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KIRKLAND
COMPOUNDING
PHARMACY

Compounding

Compounding allows us to create custom medications specifically for you.

Examples include dye-free, preservative-free, alcohol-free, and/or sugar-free forms of medications.

To learn more about our ability to customize your meds, contact us today at 425-947-5151.

Try Out Our Services

Fill out the below and we'll handle the rest.

*Required

For New Prescriptions:

Please have your provider's office send us your prescription via fax @ 425-947-5150 or electronically via e-script. List the medication info and the anticipated need/ preferred by date.

For Prescription Transfer Request:

Please leave name of Pharmacy, location, pharmacy number, the name of Medication, and anticipated need/ preferred by date. We will reach out to the pharmacy and transfer in your prescription.

Patient Information

First Name

Last Name

Date Of Birth

Month

Day

Year

Phone Number

Email

Address

City

Zip/Postal code

List and describe any allergies to medications, foods, non-foods:

List any medications you are currently taking, including supplements and as needed.

Provider's Information

Provider Name

Clinic Name

Clinic Phone

Clinic Address

Shipping & Billing

I consent to receive communication from Kirkland Compounding Pharmacy regarding my prescription and care. This includes order fulfillment, payment processing, and customer service, in accordance with the Privacy Policy.

The FDA has not reviewed, evaluated nor approved compounded preparations

to diagnose, cure or prevent disease.

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