Prescription Forms

Tear-Off Pad Request Form

We’ve created an easy-to-use prescription form to help make the process of prescribing Quell Fibromyalgia easy for you and your patients. Complete the Quell Fibromyalgia prescription form and fax it to our exclusive online pharmacy, HealthWarehouse, at 859-525-0198. You may also call them at 855-446-4375.

If you would like a tear-off pad of the Prescription form for your office, click the request button below.

Request form

Additional Links

Click here for a printable prescription form
To learn more about diagnosing fibromyalgia, click here.

Prescription Forms

Tear-Off Pad Request Form

If you would like a tear-off pad of the Prescription form for your office, click the request button below.

Additional Links

Quell Fibromyalgia is available by prescription for patients who have been diagnosed with fibromyalgia and have high pain sensitivity.