Manufactured by Micro Format, Inc.

Custom Imprinted
Medical LASER FORMAT Prescription Scripts
for use in the State of California

~ This is a SECURE Order Form ~

Micro Format, Inc. is a California State Pharmacy Board
"approved printer" of Secure Prescription Pads.

Micro Format Secure Laser Prescription Paper contains all of
the features required by the California State Pharmacy Board.

Sheet Size: 8-1/2" x 11" ~ Detached Prescription Size: 5-1/2" x 4-1/4"

click to enlarge

California Prescription Paper Imprinting Information
and your Credit Card Payment Information will be requested
AFTER you have clicked on the "Add to Your SHOPPING CART" button

Due to State of California Regulations, un-imprinted laser scripts are not available.

When Requested,
Please accurately fill-in the information that needs to be imprinted on the top of each sheet.

  • California law requires scripts must contain both the DEA# and License# for each doctor listed.
  • A copy of the DEA Registration for each doctor listed must be sent to us by FAX.
  • Printing additional names and/or locations on the back of the script is
    available at an additional charge. For additional information
    please CALL Customer Service at (800)333-0549.
California Approved Laser Prescription Paper
Item #RxL775
Sheet Size: 8-1/2" x 11"

  • Item# RxL775
    Script Size:
    5-1/2" x 4-1/4"
    Imprint up to 4 Names
    (3 Names plus Facility)

    To order ........
    Click On
    "Add to Shopping Cart"

    1,000 sheets ~ $199.00
    plus shipping
    by UPS

    2,000 sheets ~ $312.00
    plus shipping
    by UPS

    4,000 sheets ~ $539.00
    plus shipping
    by UPS

    8,000 sheets ~ $988.00
    plus shipping
    by UPS

  • Thank You for your order for Secure California Prescription Forms.
    We appreciate your business.
    Your order will ship in approximately 10 to 12 business days.
    Please allow up to 4 days for shipping by UPS.

    QUESTIONS: Please send us an e-mail
    Copyright © 2004-2013 Micro Format, Inc. ~ All Rights Reserved
    Micro Format, Inc.
    830-3 Seton Court ~ Wheeling, IL 60090
    Phone: 847/520-4699 ~ 800-333-0549
    Fax 847/520-0197

    rev 07/2013