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.