For caretakers and new patients starting our Pharmacy Services

1. Fill in as much information as possible for one medication and the doctor who prescribes or previous pharmacy where filled

2. Under NOTES: please include all relevant information for filling, specifically: drug allergies and Prescription Insurance information.

3. Under NOTES: please list all other medications prescribed by the prescriber or filled by the previous pharmacy.

4. When you select DELIVERY you will enter your address.

**Do not abbreviate Doctor as "Dr." in the "Previous Pharmacy" field. It will trigger an error.**

“If it is easier to download our forms and fill out at your convenience you may click the icons below to print! After completing please fax to 1.844.591.7250 or email to so we may start your order!”