Terms and Conditions

I understand that if my prescription is eligible for this service then the original Prescription must be provided at the time of prescription pickup.

I understand that not all prescriptions will be eligible for this service, a pharmacy team member will contact me if my prescription is not eligible (e.g. methadone).

I understand that a pharmacy team member may contact me when my prescription is ready (wait-time may vary).

By submitting this form, I am consenting to the collection and use of my personal information for the purpose of submitting my prescription to be filled by the Pharmacy I have selected. I understand that my prescription and personal information will reside at the pharmacy I have chosen.

I agree to the above terms & conditions, as well as this sites disclaimer

Prescription Questions

Is this a new prescription?

Yes No

Is this your first time filling this prescription at our pharmacy?

Yes No

Contact Information

First Name

Last Name

Select Gender

Date of Birth

Phone

Address

Take a picture of your prescription and any private insurance plans using your cell phone and submit it to us to fill your prescription.

Tips:
Can upload multiple files
Place prescription on a flat surface
Ensure the area is well lit
Keep prescription in the frame and in focus
Enable flash for best results

Photo -1

Photo -2

Photo -3

Photo -4

Upload Prescription

Terms and Conditions

Terms and Conditions

Prescription Questions

Contact Information

Quick Links

Contact Info

Contact Info