Register – Lake Elmo Compound Pharmacy

Please select your area of practice below, then fill out the form.
Once submitted, we will review your account and notify you if you have been approved/denied access.

Human Prescriber
Veterinarian

Medical Registration Form

Step 1 of 3

Legal Name of Business(Required)

Name of Clinic

Clinic Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Veterinary Registration Form

Step 1 of 3

Name of Clinic(Required)

Owner's name

First Last

****If the clinic is independently owned, please enter the owner’s full name. If the clinic is part of a corporation/parent company, please provide the name of the corporation or parent company instead.

Corporation/Parent Company Name