Request New Prescription

///Request New Prescription
Request New Prescription 2018-02-20T07:14:49+00:00

To request a new prescription from your health care provider, please complete and submit the form below.  If you need new prescriptions on more than 3 medications, please submit another request.  Online prescription requests will be checked twice daily (at 10 am and 3 pm) during business days. We will contact your doctor and make every attempt to have your prescription(s) ready as soon as possible.  Please provide a current telephone number where you can be reached during business hours in case your doctor denies the new prescription request.

Request New Prescription

  • 1. Patient Information

  • 2. Doctor Information

  • 3. Prescription Request

  • 4. Upon Doctor's Approval

  • * Schedule II Controlled Substances require a new written prescription for every fill due to federal regulations and cannot be ordered online or approved over the phone.
 

Verification

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This Is A Custom Widget

This Sliding Bar can be switched on or off in theme options, and can take any widget you throw at it or even fill it with your custom HTML Code. Its perfect for grabbing the attention of your viewers. Choose between 1, 2, 3 or 4 columns, set the background color, widget divider color, activate transparency, a top border or fully disable it on desktop and mobile.