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PRESCRIPTION REFILLS

Ordering your prescriptions on-line is fast, easy, and secure! All information submitted on our website is secure, so you can trust that all personal data remains strictly confidential. We use the latest technology 128-bit encryption software to transmit data which has been verified by GeoTrust.



To refill your prescription(s), please fill out the information below:

NAME(s):
(Enter all names if you have Rx's for more than one person.)


E-MAIL ADDRESS:
Rx NUMBERS(S)
(Enter drug name(s) and strength(s) if you've lost the Rx number(s).)
  1)       2)
  3)       4)
  5)       6)
If you have more than 6 perscriptions, please click here to visit our multiple refill page.
SPECIAL INSTRUCTIONS
(Are you a delivery patient, mail order patient, would you like any OTC drugs with your refill, etc.)
PICK UP TIME
(Please check the time of day you would like to pick up your prescription(s). If possible, please submit your refill one day before you pick up your order.)
8:00am - 10:00am (Please note that we open at 9:00am on Saturdays.)
10:00am - 12:00pm
12:00pm - 2:00pm
2:00pm - 4:00pm
4:00pm - 6:00pm (Please note that we close at 5:00pm on Saturdays.)
6:00pm - 8:00pm
Following Day or Later
Submitting your refill order(s) at least one day in advance allows us time to complete your order and to call your doctor if need be and generally helps minimize delays at the time of pickup.
PAYMENT METHOD
(If you choose to pay for your prescription(s) when you get to the store or by using the credit card we have on file, you may skip to the bottom of this form and click the ORDER REFILLS button.)
Pay in Store
Use Credit Card on File (If you have asked us to keep your credit card on file and wish to pay using this card, please select this option.)
Pay Online by Credit Card

Only fill out the following information if you chose the "Pay Online by Credit Card" option. Otherwise, you may now submit your order by clicking the ORDER REFILLS button below.

NAME ON CREDIT CARD:


CREDIT CARD NUMBER:


EXPIRATION DATE:
(Please use four digits in the form of MMYY. For example, January of 2005 would be 0105.)
SUBMIT ORDER
That's it! Click the submit button below and your order will be processed.
 
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