Avita Pharmacy can only accept original prescription drug orders from patients. 
Faxed prescriptions can be accepted only from the prescribing practitioner.

Patient Enrollment Forms

 

 Baton Rouge,
Louisiana

 

 

 

 New Orleans | Tulane Tower
Louisiana

 

 

 

 

 

New Orleans | Marine Building
Louisiana

 

 

 

 

 

 Salisbury,
North Carolina

 

 

 

 

 

 

 

 Dallas,
Texas

 

 

 

 Houston,
Texas

 

 

 

 

 

 

 San Antonio,
Texas

 

 

 

 

Florida

 

 

 

 

Hepatitis C Enrollment Forms

 

 

Baton Rouge,
Louisiana

 

 

 

 

 

 

New Orleans,
Louisiana
[all locations]

 

 

 

 

 Salisbury,
North Carolina

 

 

 

 

 

 

San Antonio,
Texas

 

 

 

 

 

 

 

 

Dallas,
Texas

 

 

 

 

 

Houston,
Texas

 

 

 

 

 

 

Houston | St. Hope

 

 

 

 

 

 

 

 

Additional Enrollment Forms

 

 Lupron Depot Referral Form

 

 

 Rheumatology
Referral Form

 

 

 

 

 

 

 

Dermatology
Referral Form