I accept the Privacy Policy and authorize receiving important communications by email and text messages (SMS) from Logos RX about my account.

I (we) hereby authorize Logos Pharmacy to make charges to my payment method below. All records are kept in a secure file accessible to authorized personnel only. All payments are due upon receipt and unpaid balances may lead to late payment penalties and account closure.

It is understood that Logos Pharmacy utilizes FedEx and UPS as methods of shipping. Logos Pharmacy will choose the most affordable shipping vendor and method unless the “RUSH” preference is noted on the prescription in which case the method will always be UPS/FedEx standard overnight. See shipping rate sheet for the most up to date pricing.

It is understood that by choosing non-signature required delivery, the physician and/or patient is accepting full responsibility regarding the delivery of the prescription. In the event the shipping vendor indicates a successful delivery for a non-signature required package and the recipient states the package was not delivered, the patient and/or clinic will be responsible for payment of a replacement order.

This Provider Agreement is by and between Logos RX  and “Prescriber” wherein each of the parties agree as follows:

1. Prescriber acknowledges this purchase is from Logos RX for a specific patient of Prescriber’s practice.

2. Logos RX agrees that it provides patient specific compounded preparations to the Prescriber practice subject to the terms of this Provider Agreement.

3. Each of the Parties agree to the following terms:

i. Any patient specific compounded preparations prepared by Logos RX  are received by Prescriber as an agent of the patient and shall not be re-dispensed to the patient of the Prescriber or dispensed to any third party or entity;

ii. The Prescriber will provide all packaged literature to the patient for the medication usage instruction and for the reporting of any adverse reaction of complaint in order to facilitate any recall of batches of compounded preparations.

4. Logos RX maintains a record of all patient specific compounded preparations distributed to the Prescriber as an agent of the patient and such records shall include the date of the prescription, name, address, and phone number of the Prescriber who ordered the preparation and the name, strength and quantity of the preparation ordered and the LOT number of each preparation.

If you understand and agree to all the terms herein, please sign below prior to submission of Provider Agreement.