• 1. Existing patients: Please fill out Patient’s Name, DOB, and Phone.
    1. New patients: Please fill out the rest of this form (Address, Phone Numbers, etc).
    2. Take a picture and upload a photo of your prescription or Rx bottle (Please limit 1 Rx or bottle per photo).
    3. Bring your original prescription with you to the pharmacy.
    4. Allow us to do the rest. Easy!

Add Your Refills