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If you’re a patient, we’re here to help you fill prescriptions or provide you with the information you need to work with your doctor to help decide if a compounded prescription might be a good treatment for you.
Prescribers, for additional information on our compounded therapies, including pricing, fill out the form below.


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    Please choose one.




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    Clinic State*

    How would you like us to contact you?*

    How many patients do you see monthly?*

    Your Title?*

    What are you interested in?*:
    Hormone TherapyNon-Sterile MedicationsSterile MedicationsTopical Numbing Creams

    Do you have a prescription to submit today?*:
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    When would you like to start prescribing?*

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    To protect your privacy, please do not provide information personal to your medical history or medication you currently take.

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    • Custom Rx

      3510 N Ridge Rd, Ste. 900
      Wichita, KS 67205

      Ph: 316-721-2626
      Fax: 316-721-4823

      Toll-Free Phone: 855-287-6879
      Toll-Free Fax: 855-721-4823

    • Hours

      Monday-Friday: 9am to 6pm