Pharmacist & Inquiry Support: 385.279.4420 | info@genesiscompounding.com

Welcome, Prescriber. Let's Get You Started.

Genesis Compounding is built for prescribers who want individualized medicine without friction. Complete the online enrollment form below to establish your prescriber account, then submit prescriptions securely through our online Rx submission form — no downloads, printing, or faxing required.

Fax: 385-855-1221
Email: info@genesiscompounding.com
Phone: 385.279.4420
1

Complete Enrollment Online

Fill out the clinic enrollment form below and submit — no download or printing required.

2

Get Verified

Our team reviews your details and confirms your prescriber account, usually within one business day.

3

Submit Prescriptions

Once verified, send prescriptions securely through our online Rx submission form.

Clinic Enrollment Form

Complete this form online to establish a new prescriber account with Genesis Compounding. On submit, your details are emailed directly to our pharmacy team — no printing, faxing, or downloads required. All fields marked with an asterisk are required.

Your submission is emailed securely to our pharmacy team at pharmacy@genesiscompounding.com.

Prescription (Rx) Submission

Verified prescribers can submit a new prescription securely online — either attach a completed/signed prescription file or enter the Rx details directly. On submit, your prescription is transmitted to our pharmacy team for processing.

Protected Health Information (PHI): This form transmits patient health information. Only submit prescriptions for patients you are authorized to treat. Genesis Compounding handles this information in accordance with our HIPAA Notice of Privacy Practices. Do not include payment card information on this form.
Optional if you complete the Rx details below. Accepted: PDF, JPG, PNG. Signed prescriptions preferred.
Transmitted securely to pharmacy@genesiscompounding.com.
Note for IT / Web Team (remove this box before go-live if desired):
Both forms above POST to https://formsubmit.co/pharmacy@genesiscompounding.com, a no-backend form-to-email relay that requires no account. On the first real submission FormSubmit sends a one-time confirmation email to pharmacy@genesiscompounding.com — click the activation link once to enable delivery. The endpoint supports file attachments (used by the Rx upload field).

If you prefer to route submissions through your own infrastructure (e.g., HubSpot, a HIPAA-compliant form service, or an internal mail handler), simply change the action attribute on each <form> to your endpoint. For PHI/HIPAA, a Business Associate Agreement (BAA) with the form/email provider is recommended — FormSubmit is convenient but does not offer a BAA, so confirm your compliance requirements before go-live for the Rx form.

Have questions about becoming a prescribing partner?

Call Us: 385.279.4420 Email Our Team