1 Part (#6 FORMAT, PRESCRIBING EYE WEAR) NEW JERSEY Rx Pads

Must be used for all prescriptions filled in New Jersey FOR EYE WEAR. Imprinted with black ink. Includes all security features as required by State of New Jersey.

To process New Jersey Mandated Prescription Pads, we must receive a copy of the DEA license and the New Jersey Medical or Dental License by fax at (800) 256-1433, once you have placed the order online. DOWNLOAD ORDER FORM BELOW.