Refills/Transfers

Please fill out all fields and click on Send Refill Information to have your refill processed. You may enter up to five separate refill numbers on this form.

Important Prescription Information:

1. Please note, if you are out of refills, or your prescription has expired, we must contact your physician for authorization. This may delay your order.
2. For refills on compounded medications, please allow a 48 hour (two weekdays) turn around time for completion of your order.
3. Some prescription numbers may be preceded by a letter. Enter only the numbers in the fields below.
4. For orders being delivered by UPS, please enter your shipping address above. No P.O. boxes please.
*(denotes required field)
Name: *
E-Mail Address: *
Phone *
Mailing Address
City
State
Zip
First Refill Number
Second Refill Number
Third Refill Number
Fourth Refill Number
Fifth Refill Number
Insurance Form Needed
Delivery Method
Pick-UpUPS
Delivery Speed
NoneGround2nd DayOvernight
Comments



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