WEBEASY RX - Register For Your WebEasy RX Site

Register for Your WebEasy RX Site Here

Store Name:
Street Address:
City:
State:
Zip:
Phone:
Fax:
Current Email Address:
Pharmacy Contact:
NABP#:
Please Provide Four Choices for Your Domain Name: (ex. yourpharmacy.com or yourpharmacy.com/north)
www.
www.
www.
www.
Pharmacy Hours: (ex. 8am-5pm)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
States Licensed In:
Staff Members to be Highlighted:

I will email pictures of staff and pharmacy (interior/exterior) to be included on the website to sales@webeasyrx.com:
	Yes No
I would like to include my pharmacy logo on my website:
	Yes No
You can create up to six email accounts at no additional cost to your pharmacy. (ex. john@yourpharmacy.com, or askthepharmacist@yourpharmacy.com) Do you want to have an "Ask the Pharmacist" account? (This account will be used by your patients to email questions they have regarding their medications or other health-related topics.)
	Yes No
EMail Account Name:	Password:






General Store Services: (check if applicable)
Charge Accounts	Delivery Service
Emergency Service	Card Shop
Gift Shop	Photo Finishing
Unique/Special Services: (check if applicable)
Hypertension	Diabetes Education
Asthma	Osteoporosis
Smoking Cessation	Anticoagulation
Hyperlipidemia	Women's Health
Long-term Care	Weight-Loss
Compounding	other
Corporate Colors:
Additional Information:

WAVERLY, Iowa-Competition among pharmacies has never been more fierce. Community pharmacies' competitors-other community pharmacies and large chains-are turning to new ways to lure away patients, including the Internet.

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