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In The News

"If all drugs in the United States were sold at Canadian prices, American consumers would save up to $38 billion a year."

 

Senator Byron Dorgan

D-North Dakota


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1-866-444-6376

Refills Orders Only 


Complete this simple Refill Order Request Form below and we will process and ship your refill immediately.

 

Allow up to 21 days for the delivery of your refills once you receive email confirmation from us.

 

We will use the payment information that we have in your file.

 

If there has been a change in your payment information or you prefer to speak to one of our staff, please call our toll free number 1-866-444-6376.

 

If you are an existing client and need a NEW prescription filled, just FAX it Toll Free to 1-866-444-6378 and we will process it.  Please make sure your NAME and PHONE NUMBER is clearly written or printed somewhere on your forms.

 

Refill Order Request Form

(Please fill out completely)


 

Patient Information

 

      Your Full Name: 

      Street Address: 
      City:      State:       Zip Code: 
      Telephone: (area code + phone number)
      Best Time to Call: 
      E-Mail Address: 
 

 

Medical History Update

Has the patient had a complete physical exam in the past 12 months. (Mandatory)
Has anything changed in the Health and Medication Use?

       If YES  to "Change in Health and Medication Use"

       Explain in Detail below.


Medications to Refill

Drug Name

As on Prescription

Strength

(mg,%,etc)

Qty

Amount

Price

Current

Shipping Charges:   $11.95 USD

   Total:  

       Comments or Instructions.

Please be sure ALL information is correct.  Your refill order will go for processing and can NOT be changed or stopped once submitted. 


 

Products mentioned are registered trademarks of their respective companies.

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