Ordering a refill is simple, fill out the form below and press the “Submit” button. Your order will be shipped within 24 hours.

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Personal Information


*Date of Birth:



Prescription Information

*Medication Rx#:

*Days Supply On Hand:

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After you click the submit button you will receive a confirmation email within an hour. If you do not receive an email, please call us immediately at 1-866-437-8040

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