Auto Refill Rx

To enroll in our auto refill program, please submit the information below:

* = Required Information

Who is this prescription for?

Name*

Email*

Phone*

Yes, I want my prescriptions to be automatically refilled when it is due.
Tick this box if you want automatic refills.

Would you like us to notify you when your prescription(s) are ready?

Yes, via phone


No, thanks