Download Instructions

Thank you for referring your patients to Origin! 🎉

To ensure we’re able to accept your patient’s prescriptions, please…

  1. Select the state in which you treat from the list of available states below
  2. Download the prescription form provided for your state– this can not be substituted for another form, since each state has different requirements
  3. Review the form’s instructions (in red) before completing it

Available States

California (CA)

Kentucky (KY)

New York (NY)

Ohio (OH)

Texas (TX)

Not sure how to refer patients in your state? Email